Primary HPV testing recommendations of US providers, 2015

Abstract

Objective To investigate the HPV testing recommendations of US physicians who perform cervical cancer screening. Methods Data from the 2015 DocStyles survey of U.S. health care providers were analyzed using multivariate logistic regression to identify provider characteristics associated with routine recommendation of primary HPV testing for average-risk, asymptomatic women ≥30 years old. The analysis was limited to primary care physicians and obstetrician-gynecologists who performed cervical cancer screening (N = 843). Results Primary HPV testing for average-risk, asymptomatic women ≥30 years old was recommended by 40.8% of physicians who performed cervical cancer screening, and 90.1% of these providers recommended primary HPV testing for women of all ages. The screening intervals most commonly recommended for primary HPV testing with average-risk, asymptomatic women ≥30 years old were every 3 years (35.5%) and annually (30.2%). Physicians who reported that patient HPV vaccination status influenced their cervical cancer screening practices were almost four times more likely to recommend primary HPV testing for average-risk, asymptomatic women ≥30 years old than other providers (Adj OR = 3.96, 95% CI = 2.82–5.57). Conclusion Many US physicians recommended primary HPV testing for women of all ages, contrary to guidelines which limit this screening approach to women ≥25 years old. The association between provider recommendation of primary HPV testing and patient HPV vaccination status may be due to anticipated reductions in the most oncogenic HPV types among vaccinated women.

Factors associated with high-risk human papillomavirus test utilization and infection: a population-based study of uninsured and underinsured women

“…While we did not examine provider characteristics in the current study, we hypothesize that they are important to understanding variation in cervical cancer screening and HPV DNA testing across counties and by NJCEED providers. Prior studies have shown that variation exists in providers’ adherence to screening guidelines and specifically in recommendations for HPV testing [ 16 , 39 – 42 ].…”

Are Health Care Professionals Prepared to Implement Human Papillomavirus Testing? A Review of Psychosocial Determinants of Human Papillomavirus Test Acceptability in Primary Cervical Cancer Screening

“…Against recommendations for age-specific practices, 31-43% of HCPs would prematurely initiate cervical screening before age 21 with either cytology or co-testing (16,17) . For women in the age range 21-29, practitioners generally over-screened by performing annual Pap tests (74% of OB/GYNs) (17) , 35-85% of HCPs (lowest proportion among OB/GYNs) inappropriately screened with the co-test (36,40,44,46) and recommended it yearly or every three years (13-42% of OB/GYNs, FPs, IMs, NPs, PAs) (16,44) . Cooper et al (2017) found that for women less than 25 years old, approximately 24% of OB/GYNs and 43-61% of FPs and IMs would incorrectly recommend the HPV test alone (46) .…”

“…For women in the age range 21-29, practitioners generally over-screened by performing annual Pap tests (74% of OB/GYNs) (17) , 35-85% of HCPs (lowest proportion among OB/GYNs) inappropriately screened with the co-test (36,40,44,46) and recommended it yearly or every three years (13-42% of OB/GYNs, FPs, IMs, NPs, PAs) (16,44) . Cooper et al (2017) found that for women less than 25 years old, approximately 24% of OB/GYNs and 43-61% of FPs and IMs would incorrectly recommend the HPV test alone (46) . In women aged 30-65 years, reported co-testing use is highly variable: 28-80% among HCPs in the US (17,19,20,30,36,40) and 28% among OB/GYNs in Italy (39) .…”

“…In the US, 23-43% of HCPs stated they do not conduct an HPV test at all in women 30-65 years old (17,30) . In women aged 30 to 65 years, with a normal Pap result and negative HPV test results, over-screening remained an issue as 25-48% of HCPs (higher among OB/GYN than FP) perform/would perform co-testing every three years instead of the recommended five years (16,40,46,48) or even at one or two year intervals (20-55% of physicians) (19,30,41,46,48) . After a negative HPV test, 44% of Italian OB/GYNs comply with European guidelines and recommend the next HPV test after five years (48) .…”

The Next Generation of Cervical Cancer Screening: Should Guidelines Focus on Best Practices for the Future or Current Screening Capacity?

“…A recent survey of primary care physicians and obstetrician-gynecologists found that approximately 30% of them would recommend asymptomatic women aged 30 years and older undergo annual screening with HPV testing. 52 Financial incentives/disincentives may be a solution, but the jury is still out as to whether payment-for-performance strategies improves adherence. 53 , 54 …”