Poster #365: 2012 Consensus Pap Test Guidelines Women’s Perceptions and Expectations
SAN FRANCISCO - Women know that Pap tests are a useful screening test for cervical cancer, but according to a new study led by researchers at the Perelman School of Medicine at the University of Pennsylvania, most of those surveyed are unaware of the updated screening guidelines for the appropriate frequency of Pap tests in low-risk women. Nearly half of women were unsettled by the idea of spacing out Pap tests and reported that they planned to continue annual testing despite the change in recommendations. Results of the study were presented earlier this week at the 2015 American Congress of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting in San Francisco.
In March 2012, revised consensus screening guidelines were released by the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology and soon after endorsed by the American Congress of Obstetricians and Gynecologists. These guidelines recommend that women have their first Pap test at age 21. Although earlier guidelines recommended that women begin Pap test screening three years after they become sexually active, waiting to begin testing until age 21 is now recommended because adolescents will likely clear the Human Papillomavirus (HPV) on their own without any persistent cervical cell abnormalities.
Additionally, according to the updated guidelines, low-risk women aged 21 through 29 should be screened with a Pap test only every three years. Low-risk women between 30 and 65 can subsequently be screened every five years with Pap and HPV co-testing, or every three years with a Pap test alone.
“Our population was very knowledgeable about the purpose of Pap test screening and the cause of cervical cancer,” said lead author Katherine O’Flynn O’Brien, MD, an Obstetrics and Gynecology resident at the Hospital of the University of Pennsylvania. “Unfortunately, most women were unaware of the appropriate frequency for Pap tests and many felt uncomfortable with the increased screening intervals recommended by the new guidelines. Our study highlighted a large opportunity for improvement as the majority of our patients noted that further education about the new guidelines would improve their comfort with the changes in screening. We have a responsibility to empower our patients with the information they need to make informed decisions about their screening choices and to reduce their morbidity from receiving unnecessary testing which can lead to further procedures due to false positive results.”
In the study, a 13-question anonymous survey was made available to patients 18 years of age and older who presented for obstetric or gynecologic care. Survey topics included familiarity with the revised 2012 consensus screening guidelines, knowledge of cervical cancer, and attitudes toward screening frequency. The investigators found that of 249 respondents, more than 90 percent identified Pap tests as a screening test for cervical cancer and 85 percent named HPV as the cause of cervical cancer. The correct screening intervals for patients aged 21 to 29 years old were selected by 15 percent of respondents, and only six percent selected the appropriate screening interval for patients aged 30 years and older. Overall, 46 percent were uncomfortable with lengthening screening intervals and 47 percent would prefer a yearly Pap test. However, 67 percent believed that additional education would increase their comfort with less frequent Pap tests.
Other Penn co-authors are Danielle Burkland, MD, director of Penn’s Helen O. Dickens Colposcopy Clinic and Penn’s principal investigator on the study, Anne Elizabeth Nichols, BS, and Ashley Ford Haggerty, MD. Jill M. Krapf, MD, principle investigator from George Washington University and Karin Karpin, BS, are also co-authors.
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