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Pap and HPV Tests for Cervical Cancer Screening Given Too Often; Conflict with Guidelines

Centers of Disease Control & Prevention investigators find physicians not close to national recommendations

Aug. 18, 2011 – Investigators from the Centers for Disease Control and Prevention (CDC) have determined that the majority of primary care providers continue to recommend annual cervical cancer screening, and less than 15% would extend the screening interval when using the Papanicolaou test and human papillomavirus (HPV) test together, as some guidelines suggest.

Current cervical cancer screening guidelines, issued by the American Cancer Society in 2002 and the American College of Obstetricians and Gynecologists in 2003, recommend a combination of a Papanicolaou test and an HPV test, known as an HPV co-test, for women 30 years of age and older.

Upon screening, if the results of these two tests are normal, women can wait 3 years for their next cervical cancer screening test.

 

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Medicare helps pay for a screening Pap test every two years and may pay more often if medically necessary, according to the National Cancer Institute.

Annual cervical cancer screening, however, continues to be a common recommendation, regardless if a woman has a history of normal Pap tests or normal HPV co-test.

Approximately one-half of providers studied ordered the HPV co-test for their patients.

"Use of the HPV co-test and adherence to the extended screening interval with normal test results reduce patient harms that can be caused by over-testing, including pain, inconvenience, morbidity, and unnecessary follow-up procedures and treatments," commented lead investigator Katherine B. Roland, MPH, a behavioral scientist in CDC's Division of Cancer Prevention and Control.

"Appropriate use of cervical cancer screening technologies is essential, now more than ever, if HPV co-testing is to be considered a preventive service for women covered by insurance providers."

About Cervical Cancer

The cervix is the lower part of the uterus, the place where a baby grows during pregnancy.

Cervical cancer is caused by several types of a virus called human papillomaviruses (HPV).

The virus spreads through sexual contact. Most women's bodies are able to fight HPV infection. But sometimes the virus leads to cancer.

You're at higher risk if you smoke, have many children, use birth control pills for a long time, or have HIV infection.

Cervical cancer may not cause any symptoms at first, but later, you may have pelvic pain or bleeding from the vagina. It usually takes several years for normal cells in the cervix to turn into cancer cells.

Your health care provider can find abnormal cells by doing a Pap test - examining cells from the cervix under a microscope.

By getting regular Pap tests and pelvic exams you can find and treat changing cells before they turn into cancer.

A vaccine for girls and young women protects against the four types of HPV that cause most cervical cancers.

NIH: National Cancer Institute

Analyzing nationally representative data collected in 2006 through the CDC's National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, researchers assessed HPV testing and co-testing practices and documented the recommendations for screening intervals given by private office-based providers and hospital outpatient departments (OPDs).

The study included responses from 376 private office-based physicians and 216 physicians from hospitals and outpatient facilities. The results are published online today in the American Journal of Obstetrics & Gynecology (AJOG).

Providers who ordered the HPV co-test were asked their recommendation for the next Papanicolaou test according to 3 clinical vignettes. The vignettes describe a woman between the ages of 30 and 60 years of age with a current normal Papanicolaou test with:

   1) no current HPV test results and history of 2 consecutive normal Papanicolaou test results

   2) a current negative HPV test result and a history of 2 consecutive normal Papanicolaou test results, and

   3) a current negative HPV test result and no history of Papanicolaou tests.

The guidelines support extending the screening interval up to 3 years in each of the vignettes described.

For vignette #1, 76.4% of office-based providers and 85.2% of hospital OPDs would recommend a next screening in 12 months.

For vignette #2, 66.6% of office-based providers and 72.7% of hospital OPDs would recommend a next Papanicolaou test in 12 months. Only 14.0% of office-based providers would recommend a next Papanicolaou test in 3 years or more, as guidelines recommend.

For vignette #3, 73.4% of office-based providers and 73.5% of hospital OPDs would recommend a next Papanicolaou test in 12 months.

Establishing a history of normal Papanicolaou test results with the patient appears to be a critical component to providers making guideline-supported screening interval recommendations.

Roland added, "Our findings suggest a need for continued surveillance on cervical cancer screening guideline adherence. Evaluating provider screening behaviors, whether they reflect national guidelines and policies, and how those behaviors and policies translate to women's clinical preventive care are vital, especially in an area where science and policy are rapidly evolving."


Pap Tests for Older Women (National Cancer Institute)

This can provide older women with answers to commonly asked questions about Pap tests, HPV, and the Medicare benefit for Pap test screening.

If it has been a number of years since your last Pap test, or if you have never had a Pap test at all, this information can help put you more at ease during your appointment with your doctor.

1.        What is a Pap test?
A Pap test finds problems that can be treated before they turn into cervical cancer. A Pap test also can find cancer early. If cervical cancer is found early, it's easier to cure.

2.        Could I have cervical cancer and not know it?
YES--often cervical cancer does not cause pain or other symptoms.

3.        If I've gone through menopause, do I still need a Pap test?
Most women still need to get Pap tests. This decision depends on your age and past Pap test results. Talk with your doctor about what is right for you.

4.        If I've had a hysterectomy, do I still need a Pap test?
After a hysterectomy, you still need to get Pap tests if:

o   You had a partial hysterectomy (an operation that removed the uterus but not the cervix)

o   You had a total hysterectomy (an operation that removed the uterus and the cervix) to treat cervical cancer or a condition that might lead to cancer

You may not need to get Pap tests if you have had a total hysterectomy for other reasons (e.g., fibroids). Talk with your doctor about what is right for you.

5.        If I'm not sexually active now do I still need a Pap test?
Women who are not currently sexually active may still need a Pap test. Almost all cervical cancer is caused by a sexually transmitted virus called the (HPV) Human Papillomavirus that can live in the body for many years.

6.        How often should I get a Pap test?
You should have a Pap test at least once every 3 years. If you are age 65 or older, talk with your doctor about whether you still need to get Pap tests. You and your doctor can decide what testing schedule is right for you based on your past Pap test results.

7.        Where do I get a Pap test?

o   Doctor's office

o   Medical clinic

o   Local health department

8.        How is a Pap test done?
For a Pap test, you lie on an exam table. A nurse or doctor will use a plastic or metal instrument called a speculum to look inside your vagina. He or she then uses a small, soft brush to take a few cells from your cervix (opening to the uterus). This test takes only a few seconds. A lab will check these cells for cancer or other problems.

9.        A Pap test is important to me because it can:

o   Find abnormal cervical cell changes before they have a chance to become cancerous.

o   Tell if you have cervical cancer early—while it's still easier to cure.

10.     Does Medicare help pay for Pap tests?
Medicare helps pay for a screening Pap test every two years. Medicare may pay more often if medically necessary. For Medicare payment information, visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048.

Call your doctor or local medical clinic TODAY for a Pap test appointment.

Pap tests can save your life!

For more information on the Pap test, visit the National Cancer Institute's Web site at www.cancer.gov or call the NCI's Cancer Information Service:

·        1-800-4-CANCER (1-800-422-6237)

·        TTY 1-800-332-8615

 For Medicare Information, visit the Web site at www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048.

 

 

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