Infection Control Today (07.09.2013)
Aids Weekly Plus
HPV vaccine has been recommended for women ages 11–26 since 2006. In 2009, the American Congress of Obstetricians and Gynecologists (ACOG) issued guidelines for beginning Pap tests in 21-year-olds, decreasing screening to biennially for 21–29-year-olds, triennially for women 30 and older with normal Pap smear results or negative HPV co-testing, and discontinuing screening at age 70 or after hysterectomy for benign conditions.
Results of a survey of obstetricians-gynecologists indicated that vaccination and cervical cancer screening guidelines were not being followed. Less than one-third of obstetrician-gynecologists were administering HPV vaccine to eligible patients, and only one-half were following the cervical cancer prevention guidelines issued three years ago.
Investigators surveyed 1,000 obstetricians-gynecologists, members of ACOG, about screening and vaccination practices and barriers preventing them from following 2009 ACOG guidelines, and analyzed 366 responses. Results showed low rates of HPV vaccination. Approximately 96 percent would recommend HPV vaccine to a 13-year-old, but only 73 percent would recommend it to an 11-year-old. Half of the respondents followed guidelines to begin cervical cancer screening at age 21, discontinue at age 70 or after hysterectomy, and use Pap and HPV co-testing appropriately. Most continued to recommend annual Pap smears. Practitioners were comfortable with extended screening but felt that patients were uncomfortable with extended screening and they were concerned that patients would not show for annual exams if they did not offer Pap tests. Solo practitioners were less likely to follow vaccination and screening guidelines than those in group practice. Only 16 physicians (4 percent) reported that they followed all ACOG 2009 guidelines for cervical cancer screening.
Since the survey, the US Preventive Services Task Force, American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology issued new guidelines in 2012, which ACOG endorsed. Rebecca B. Perkins MD. MSc of the Boston University School of Medicine and lead investigator, noted that their survey results might mean a slow uptake of new 2012 guidelines unless efforts were made to improve implementation, such as programs to educate physicians and patients on the reasons why the guidelines have been changed and the evidence that drove the changes.
The full report, “Challenges in Cervical Cancer Prevention: A Survey of U.S. Obstetrician-Gynecologists,” is published in the American Journal of Preventive Medicine (2013; 45(2):175–181).