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Cervical Cancer Screening and Management Practices Among Providers in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).
Cancer 2007;110:1024–1031.
Saraiya M, Irwin KL, Carlin L, Chen X, Jain N, Benard V,
Montano DE.
Abstract
BACKGROUND: This study was conducted to describe clinicians serving women
in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP)
with regard to demographic and practice characteristics and their usual practices
in cervical cancer screening and abnormal cytology management, as well as
human papillomavirus (HPV) test use. METHODS: The authors analyzed data from
a nationally representative survey conducted in 2004 of providers practicing
7 specialties that commonly offer cervical cancer screening. The program providers
were compared with nonprogram providers. RESULTS: Program providers were found
to be significantly more likely than nonprogram providers to be midlevel providers
and to serve low-income, racial/ethnic minorities who are insured by Medicaid.
In addition, they had significantly more patients with abnormal Papanicolaou
tests and were more likely to offer onsite colposcopy (57% vs 40%). Program
providers were less likely to use liquid-based cytology (LBC) as their sole
method for cytology. Approximately 20% of program and nonprogram providers
used HPV DNA testing as an adjunct to screening cytology and two-thirds used
HPV tests to manage patients with abnormal cytology results. However, many
also used HPV testing for reasons not approved by the U.S. Food and Drug Administration
(FDA), such as for screening women age <30 years. CONCLUSIONS: As of mid-2004,
program providers served racially and ethnically diverse, low-income patients
who are at high risk for cervical cancer compared with nonprogram providers,
as intended by this program. Because many providers offered on-site colposcopy,
used LBC, and used HPV tests for patients with abnormal cytology results,
they are well equipped to reduce the risk of cervical cancer. Many program
providers used the HPV test for reasons that were not approved of by the FDA
or reimbursed by the NBCCEDP. The results of this survey have informed training
materials for program providers, reimbursement policies for LBC and HPV tests,
and interventions to discourage inappropriate HPV testing.