Many Doctors Ignore Guidelines, Order Annual Pap Test

Survey Suggests Doctors May Be Overscreening for Cervical Cancer

By Denise Mann
WebMD Health News

Reviewed by Laura J. Martin, MD

Aug. 18, 2011 -- Many doctors still recommend yearly Pap tests to screen for cervical cancer even though the guidelines suggest that some women can wait three years between negative tests, a survey shows.

The new findings appear in the American Journal of Obstetrics & Gynecology.

Overscreening for cervical cancer can result in unnecessary follow-up tests and procedures, which cause stress and pain for the women and increase costs.

In 2011, there will be an estimated 12,710 new cases of invasive cervical cancer diagnosed and about 4,290 women will die from cervical cancer, according to the American Cancer Society.

During a standard Pap test, a doctor scrapes cells from a woman's cervix and a lab examines these cells for changes indicating precancer or cancer.

A test for human papilloma virus (HPV), which is a common cause of cervical cancer, is sometimes performed in addition to a Pap test. The HPV test is optional and can be used as a screen along with the Pap test in women age 30 and older and those who have unclear Pap test results.

The American College of Obstetricians and Gynecologists recommends that cervical cancer screening be performed every three years in women who are 30 and older who are at average risk for cervical cancer and who have had three previous normal Pap tests.

Yearly Pap Tests Still Popular

Researchers analyzed data from two 2006 surveys to determine cervical screening practices and recommendations by doctors. The majority of doctors continued to recommend annual cervical screening for women in which the guidelines suggest waiting three years between negative Pap tests.

About 51% of the doctors ordered the HPV co-test as opposed to the Pap test alone, the study shows.

"If only half are using the co-test, there is a lack of understanding about the guidelines," says study researcher Katherine Roland, a behavioral scientist at the CDC. "Women should discuss with their provider whether they are eligible for extended intervals between testing or not based on the type of test that is ordered and their results."

When the researchers asked a group of doctors to make a cervical screening recommendation based on three scenarios involving women aged 30 to 60 with a normal Pap test, most doctors said they would screen annually. In each of these scenarios, however, the guidelines call for waiting three years between tests.

As to why there is a disconnect, Roland and colleagues can only speculate because the study did not look at reasons behind these screening decisions.

"There might be resistance because of patient preference for annual screening, a fear of litigation or lack of awareness of the guidelines," she says. There may also be financial incentives for doctors and labs to run these tests more frequently than the guidelines recommend, she says.

Study co-researcher Mona Saraiya, MD, of the CDC's division of cancer prevention and control, says, "Patients are playing a really key role in affecting provider behaviors, so they can say if they want to be screened with the Pap test or new HPV-co test."

Mark H. Einstein, MD, a gynecologic oncologist at Montefiore Medical Center in New York City, explains some of the dangers associated with over-screening for cervical cancer. "There is quite a bit of over-screening in women in the U.S., which ultimately leads to over-management and over-treatment," he says.

"Providers may be aware of guidelines, but to a large degree, they are not completely following them," Einstein says. "Explaining to a patient that they don't need annual testing and why it is detrimental can be a tricky conversation."

The women who are most likely to get cervical cancer haven't had screening in five years, he says.

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SOURCES: Roland, K.B. American Journal of Obstetrics & Gynecology, 2011.Mark H. Einstein, MD, gynecologic oncologist, Montefiore Medical Center, New York City.Mona Saraiya, MD, division of cancer prevention and control, CDC, Atlanta.Katherine Roland, behavioral scientist, CDC, Atlanta.American Cancer Society: "What are the key statistics for cervical cancer?" ©2011 WebMD, LLC. All Rights Reserved.

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