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A National Survey of Doctors About Screening for Cervical Cancer FREE

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The summary below is from the full report titled “Specialty Differences in Primary Care Physician Reports of Papanicolaou Test Screening Practices: A National Survey, 2006 to 2007.” It is in the 3 November 2009 issue of Annals of Internal Medicine (volume 151, pages 602-611). The authors are K.R. Yabroff, M. Saraiya, H.I. Meissner, D.A. Haggstrom, L. Wideroff, G. Yuan, Z. Berkowitz, W.W. Davis, V.B. Benard, and S.S. Coughlin.

Ann Intern Med. 2009;151(9):I-38. doi:10.7326/0003-4819-151-9-200911030-00002
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What is the problem and what is known about it so far?

Cervical cancer is cancer of the cervix (the lower part of the uterus or womb). Infection with human papillomavirus (HPV) increases a woman's chances of getting cervical cancer. People get the virus by having unprotected sexual intercourse with a person infected with HPV.

Doctors use Papanicolaou (Pap) smears to screen for cervical cancer. “Screening for cancer” means looking for cancer before a person has symptoms. To perform a Pap smear, doctors use a swab during an internal examination of the vagina to take a sample of cells from the cervix to look at under a microscope. If the Pap test shows abnormal cells, the woman needs a test called colposcopy. Colposcopy lets doctors look at the cervix with magnification and take larger samples of abnormal areas to search for cancer.

Having a Pap smear every 1 to 3 years prevents cervical cancer by finding it at early, treatable stages. It is also possible to test for HPV, but we do not yet know the best way to combine HPV and Pap tests in cervical cancer screening. Some doctors test women for HPV only if the Pap smear shows abnormal cells that are not clearly cancerous. Other programs use both tests together for all women older than 30 years. Several organizations have guidelines for cervical cancer screening. These guidelines specify the ages to start and stop screening and how often to screen based on a woman's health and sexual history.

Why did the researchers do this particular study?

To compare the cervical cancer screening behaviors of gynecologists, family doctors, and internal medicine doctors.

Who was studied?

A national sample of 1212 primary care doctors (gynecologists, family doctors, and general internal medicine doctors) during 2006 to 2007.

How was the study done?

The doctors were given a survey that asked about themselves and their practices. It also gave short descriptions of hypothetical patients with different ages and different sexual, health, and screening histories. The researchers asked the doctors how they would screen each of these patients for cervical cancer. The researchers compared the doctors' answers with the guidelines. They also compared the recommendations of the 3 specialties.

What did the researchers find?

Most of the surveyed doctors said that they provided Pap tests. However, less than one quarter of surveyed doctors had survey responses that completely agreed with guideline recommendations. Internal medicine doctors most often reported screening practices that agreed with the guidelines, followed by family doctors and then gynecologists. Yet, only 27.5% of internists had guideline-consistent responses. When the doctors' responses differed from guideline recommendations, it was usually because the doctors recommended screening when the guideline did not or more often than the guideline did.

What were the limitations of the study?

This study only asked the doctors what they would do; it did not collect information on how the doctors screened real patients.

What are the implications of the study?

Many doctors reported cervical cancer screening practices that do not agree with the guidelines and reported overuse of cervical cancer screening.





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