Pap tests used more often then screening guidelines call for

Researchers say patient demand for the test and lag time between revisions to screening recommendations and implementation may be reasons for overuse.

By Christine S. Moyer — Posted Nov. 20, 2009

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Most physicians who use Pap tests to screen for cervical cancer do not follow all of the screening guidelines, according to a study in the Nov. 3 Annals of Internal Medicine (link)

A cross-sectional survey of more than 1,200 primary care doctors found that only 27.5% of internists, 21.1% of family physicians and 16.4% of ob-gyns follow the most recent Pap test screening recommendations established by the American College of Obstetrics and Gynecology, the American Cancer Society and the U.S. Preventive Services Task Force.

"I was surprised that so many physicians said guidelines were very influential in their practice, [but] when we looked at [the survey responses], very few doctors had guideline-consistent recommendations," said Robin Yabroff, PhD, epidemiologist for the National Cancer Institute and an author of the study.

The authors concluded that Pap tests were most likely to be overused rather than underused. And factors possibly influencing the overuse included the relatively new cervical cancer screening guidelines (substantially revised during 2002 and 2003); inconsistent guidelines in screening frequency; and patient demand for the test, even when it's not recommended.

Physicians should educate their staffs on the updated guidelines, said Mona Saraiya, MD, MPH, an author of the study and medical epidemiologist at the Centers for Disease Control and Prevention's Division of Cancer Prevention and Control. She also suggested that physicians counsel patients on the new guidelines.

Still, Yabroff wants to be clear to physicians that the key is balance.

"Most women who are diagnosed with cervical cancer have not been screened recently," Yabroff said. "It's really critical to maintain that balance. I would hate for the message to be, 'You're screening too much, stop.' "

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