Aug 7, 2013

Cervical Cancer Prevention Efforts May Be Lacking

NEW YORK (Reuters Health) Aug 07 – Gynecologists are not generally complying with guidelines for cervical cancer screening and human papillomavirus (HPV) vaccination, a survey shows.

“Changing clinical practice is always challenging, but women’s health will benefit if we can focus on vaccinating teens against HPV instead of waiting for HPV to cause precancerous changes in the cervix that require invasive treatments in adult women,” Dr. Rebecca B. Perkins told Reuters Health by email.

To gauge the effect of 2009 guidelines from the American Congress of Obstetricians and Gynecologists, Dr. Perkins of Boston University School of Medicine and colleagues surveyed obstetricians and gynecologists.

Out of 1,000 doctors surveyed, 366 provided usable responses, according to a report this month in the American Journal of Preventive Medicine.

Although 92% offered HPV vaccination, only 27% estimated that most eligible patients received vaccination.

Thirty-one percent of physicians saw no major barriers, but 56% stated that parents declined to vaccinate their daughters.

As many as 42% said young adult women declined vaccination themselves. About a quarter (23%) also cited financial concerns.

Twenty-one percent said they forget to offer the vaccine.

Only 40% of physicians offer vaccination to lactating women, which is permissible under current guidelines, but 10% offer the vaccine to pregnant women, which is not recommended.

About half of respondents followed guidelines to begin cervical cancer screening at age 21 years, discontinue screening at age 70 years or after hysterectomy, and appropriately utilize Pap and HPV co-testing.

“Unfortunately” the authors say, the surveyed physicians were more likely to follow non-evidence-based practices, such as continuing screening for women aged >70 years and after hysterectomy for benign indications, than to follow current evidence-based recommendations.

It’s possible, the researchers suggest, that “programs to educate physicians and patients on the evidence behind universal HPV vaccination and extended-interval cervical cancer screening with Pap and HPV co-testing could help improve the quality of cervical cancer prevention.”

Commenting on the study by email, Dr. Russell Harris of the University of North Carolina at Chapel Hill, co-author of an editorial published with the report, put the findings on screening in a wider context.

Although the benefits of cervical cancer screening have been amply demonstrated, Dr. Harris noted, “Screening is a double-sided sword that can lead to either benefit or harm. Many people and physicians do not fully appreciate the harms side of the blade.”

“The harms of screening can be quite serious, leading to being told you have a condition which you don’t have, being treated for a condition you don’t need treatment for, and living with the worry and fear of a threat that isn’t really there. It can, quite simply, change one’s life.”

“Recently,” Dr. Harris concluded, “scientific groups have been recommending less intensive screening (for example, less frequent breast cancer screening and cervical cancer screening, stopping prostate cancer screening, and screening for colorectal cancer with less invasive tests). Much of these ‘do less’ recommendations are due to a greater appreciation of the harms of screening.”


Am J Prev Med 2013;45:175-181.


— David Douglas


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