Physicians do too many Pap tests

Most physicians continue to recommend annual cervical cancer screening, despite guidelines recommending that low-risk women be tested less frequently, a survey found.

Researchers from the Centers for Disease Control and Prevention gave clinicians three clinical vignettes. The vignettes describe a woman between the ages of 30 and 60 years of age with a current normal Pap test and: 1) no current human papillomavirus (HPV) test results and history of 2 consecutive normal Pap test results, or 2) a current negative HPV test result and a history of 2 consecutive normal Pap test results, or 3) a current negative HPV test result and no history of Pap tests.

In all three cases, guidelines would support extending the screening interval up to three years. Yet two-thirds or more of the physicians (who were divided into categories by specialty and office or hospital-based practice) recommended a next screening in one year. Less than 15% of them recommended waiting for three years. Specialists in obstetrics/gynecology were no more likely to recommend the longer interval than generalist physicians. The survey also asked clinicians about their use of the HPV co-test and found that about half were using it. Results were published online by the American Journal of Obstetrics and Gynecology on Aug. 18.

Given that the study data was collected in 2006, the limited uptake of the HPV test is understandable, since it was only FDA-approved and guideline-recommended in 2003, the study authors said. However, the recommendation for longer screening intervals predates the HPV test and therefore, providers' lack of adoption of that guideline is more concerning. Overtesting increases patients' pain, inconvenience, morbidity and general health care costs, the authors said. They recommended continued surveillance and data collection on this question as well as promotion of evidence-based screening policies.

ACP is developing recommendations for the appropriate use of testing in a wide variety of clinical scenarios as part of its High-Value, Cost-Conscious Care Initiative, which will assess benefits, harms, and costs of diagnostic tests and treatments for various diseases to determine whether they provide medical benefits that are commensurate with their costs and outweigh any harms.