Assessing Physician Adherence to Guidelines for Cervical Cancer Screening and Management of Abnormal Screening Results

• Published in: Journal of lower genital tract disease Vol. 24; no. 4; p. 337
• Main Authors: Min, Caroline J, Massad, L Stewart, Dick, Rebecca, Powell, Matthew A, Kuroki, Lindsay M
• Format: Journal Article
• Language: English
• Published: United States 01.10.2020
• Subjects: Adult; Aged; Cross-Sectional Studies; Early Detection of Cancer; Female; Guideline Adherence - statistics & numerical data; Gynecology; Humans; Middle Aged; Missouri; Obstetrics; Physicians - statistics & numerical data; Surveys and Questionnaires; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - pathology; Vaginal Smears - statistics & numerical data; Missouri
• ISSN: 1526-0976
• DOI: 10.1097/LGT.0000000000000558

The aim of the study was to survey obstetrician-gynecologists' cervical cancer screening practices and management of cervical abnormalities to ascertain adherence to guidelines. From January to July 2019, obstetrician-gynecologists at 5 St. Louis area hospitals were surveyed online about cervical cancer screening and management practices through 13 clinical vignettes. Survey scores and the American Society of Colposcopy and Cervical Pathology (ASCCP) app use were compared using Mann-Whitney tests. When screening 30- to 65-year-old participants, 114 (98%) of the 116 total participants used co-testing, but only 71 (61%) screened at 5-year intervals. None used primary human papillomavirus (HPV) testing. For 21- to 29-year-old participants, 17 (15%) screened with annual cytology, whereas 14 (12%) used annual or every 3-year co-testing. Forty eight (41%) screened younger than 21 years, regardless of risk factors or only if immunocompromised. Eleven (9%) continued screening after total hysterectomy for benign indications. Only 2 (2%) responded to all clinical vignettes in adherence to guidelines. More than 30% of participants would pursue unnecessary HPV testing and/or loop electrosurgical excision procedure for persistent low-grade cytology. Fifty eight (48%) incorrectly reported hysterectomy as management for adenocarcinoma in situ on biopsy. Participants would undertreat young women with high-grade abnormalities including high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia 3 (48, 41%) and high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia 1 (65, 56%). Forty one (35%) reported exiting women from screening prematurely. The median score for participants using the ASCCP app was significantly greater than those who did not (79% vs 71%, p = .002). Midwestern obstetrician-gynecologists' adherence to the guidelines for cervical cancer screening and management of abnormal results is suboptimal. Although co-testing for women aged 30-65 years has been broadly adopted, primary HPV testing has not. Physicians overscreen, overtreat low-grade lesions, and undertreat high-grade lesions in young women.