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Cervical cancer screening, abnormal cytology management and counseling
practices in the United States.
The American College of Obstetricians and Gynecologists. 2006;
108(2):397-409.
Irwin KL, Montano D, Kasprzyk D, Carlin L, Freeman C, Barnes R, Jain
N, Christian J, Wolters C.
Abstract
OBJECTIVE: We assessed clinician knowledge and practices since the marketing
of tests for sexually transmitted human papillomavirus (HPV) and the release
of HPV testing guidelines for two indications: 1) as an adjunct to cytologic
screening and 2) to guide colposcopic triage of patients with atypical squamous
cells of undetermined significance (ASC-US) cytology results. METHODS: In
mid-2004, we surveyed nationally representative, random samples of clinicians
practicing specialties that provide cytologic screening. Mail surveys addressed
HPV-related knowledge, screening, abnormal cytology management, HPV testing,
and counseling practices. RESULTS: The overall adjusted response rate was
82%. Of the 2,980 (89%) clinicians providing cytologic screening, 99% knew
that HPV infection increases cervical cancer risk, and 91% were aware of
HPV tests. Of the 21% who reported ever using HPV tests as an adjunct to
cytology, more reported usually testing patients aged less than 30 years
(which guidelines do not recommend) than older patients (which guidelines
do recommend). Of the 63% of clinicians who ever ordered HPV tests for abnormal
cytology results, 84% usually ordered tests for ASC-US results and preferentially
advised colposcopy if HPV tests were positive, as guidelines recommend. However,
more than 60% usually ordered HPV tests for higher-grade abnormalities, which
is not recommended for colposcopy triage. Although few sought HPV test consent,
most discussed sexually transmitted HPV with patients with abnormal cytology
or positive HPV tests despite potentially negative psychosocial consequences.
CONCLUSION: New HPV tests and testing guidelines have transformed screening,
abnormal cytology management, and counseling practices. Although many U.S.
clinicians reported using HPV tests according to guidelines, many also reported
inappropriate use.