Physicians Slow to Implement HPV Vaccination and Cervical Cancer Screening Guidelines

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July 15th, 2013

Despite recent breakthroughs in cervical cancer prevention resulting in new vaccination and cervical cancer screening guidelines, a Boston University School of Medicine (BUSM) study published this month’s American Journal of Preventive Medicine found that physicians are slow to implement these guidelines into their practices.

Researchers found that less than one third of obstetrician-gynecologists vaccinate their eligible patients against HPV and only half follow cervical cancer prevention guidelines published three years ago. Patient and physician interactions were also identified as a crucial component of whether patients adhere to the recommended vaccinations and screening guidelines.

“Providers stated that the largest barrier to human papilloma virus (HPV) vaccination was patients and parents declining to receive the vaccine. However, studies indicate that most patients support HPV vaccination, and that a strong physician recommendation is the most important determinant of vaccine uptake in young women,” said principal investigator Rebecca Perkins, MD, MSc, an assistant professor at BUSM.

Vaccination against HPV has been recommended for women aged 11–26 years since 2006. In 2009, the American Congress of Obstetricians and Gynecologists (ACOG) issued guidelines recommending the initiation of Pap tests for 21-year-old women, decreasing the frequency of screening with age. The survey, which analyzed responses from 366 ACOG obstetrician-gynecologists, found low rates of HPV vaccination. Although 92 percent of respondents offered HPV vaccination to patients, only 27 percent estimated that most eligible patients received vaccination.

Approximately half of the respondents followed guidelines set by the ACOG in 2009 and most physicians continued to recommend annual Pap test. However, the physicians surveyed believed that patients were uncomfortable with extended screening intervals and would not come for annual exams if a Pap was not offered.

Solo practitioners were less likely to follow both vaccination and screening guidelines than those in group practices. Only four percent of physicians reported adherence to all 2009 ACOG guidelines for cervical cancer screening.

In 2012, the U.S. Preventive Services Task Force, American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology issued new guidelines, which have subsequently been endorsed by the ACOG. The guidelines recommend triennial Paps for women aged 21–29 years and co-testing with Pap and HPV tests at five-year intervals for women aged 30–65 years, regardless of whether they have received HPV vaccination.

“In the light of persistently low HPV vaccination rates and new guidelines recommending Pap and HPV co-testing, programs to educate physicians and patients on the evidence behind universal HPV vaccination and extended-interval cervical cancer screening with Pap and HPV co-testing could help improve the quality of cervical cancer prevention,” said Perkins.

Submitted by Amy Gorel.