Adhering to Cervical Cancer Screening Guidelines: Are We Getting It Right?

Summary and Comment |
February 27, 2017

Adhering to Cervical Cancer Screening Guidelines: Are We Getting It Right?

  1. Diane E. Judge, APN/CNP

After guidelines were updated in 2012, cervical cancer screening in average-risk women was still initiated too soon and continued for too long.

  1. Diane E. Judge, APN/CNP

Ever since the cervical cancer screening guidelines were updated in 2012, clinicians have been slow to implement the recommended changes. In a retrospective cross-sectional study, researchers examined adherence to recommendations for average-risk screening initiation (age 21) and termination (age 65 if adequate previous screening or after total hysterectomy) during the 2 years following publication of the guidelines. An electronic database was used to identify Pap smears performed in 3920 women seen in >40 primary care centers in a single healthcare system in Minnesota. Charts with nonindicated Pap smears were manually reviewed for specific screening indications (e.g., immunosuppression, history of high-grade dysplasia). Initiation of screening at age ≥20.5 was deemed appropriate.

A total of 509 women younger than 21 had at least 1 Pap smear; of these, 257 (50.5%) were not indicated. In the >65-year-old group, 1327 women underwent at least 1 Pap smear; of these, 536 (40.4%) were not indicated. The most common reason for inappropriate screening in this older group was “health maintenance,” while reasons for indicated screening included inadequate previous screening and history of abnormal cervical cytology. Posthysterectomy, 2084 women had at least 1 Pap test (605 [29%] inappropriately), most commonly for “health maintenance.” Over the 2-year study period, the proportion of nonindicated Pap tests declined in the <21-year-old group, increased in the posthysterectomy group, and remained stable in the >65-year-old group.

Comment

Other studies have revealed inconsistent adherence to cervical cancer screening guidelines. Possible explanations include clinicians' unfamiliarity with or concern about appropriateness of recommendations, difficulty obtaining documentation of previous screening, and patients' requests for — or avoidance of — Pap smears. These guidelines are likely to become more complex as they increasingly reflect human papillomavirus testing and vaccination (NEJM JW Womens Health Jun 2015 and Ann Intern Med 2015; 162:851). To improve adherence, we must educate ourselves, our colleagues, and our patients.

Editor Disclosures at Time of Publication

  • Disclosures for Diane E. Judge, APN/CNP at time of publication Equity Stryker Corporation

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