Navigation Links
Doctors Overprescribing the Pap Test
Date:11/2/2009

Many ignore guidelines, recommend screening to women at low risk, survey shows,,,,

MONDAY, Nov. 2 (HealthDay News) -- In 2002 and 2003, screening guidelines for the cervical cancer-detecting Pap test were changed significantly, yet fewer than one-third of U.S. primary care physicians follow those guidelines, according to a recent study.

Many overprescribe the screen, telling researchers that they would recommend it to virgins (most cervical cancers arise from a sexually transmitted virus), women with inoperable cancers and even women who have had their cervix surgically removed.

Overall, the study found that only 28 percent of internal medicine doctors, 21 percent of general practitioners and 16 percent of obstetricians/gynecologists use the Pap screen in the recommended way.

"We conducted a nationally representative survey of primary care physicians in the U.S., and found that the majority of physicians do not have guideline-consistent screening recommendations," said the study's lead author, K. Robin Yabroff, an epidemiologist at the National Cancer Institute in Bethesda, Md.

However, the researchers also found that the physicians said "guidelines were influential in their practice," according to Yabroff.

The findings are published in the Nov. 3 issue of the Annals of Internal Medicine.

The Papanicolaou (Pap) test screening is used to detect early changes in cervical cells that might indicate cancer. In the past, it was recommended that sexually active women have the test every year.

But, in 2002 and 2003, the American Cancer Society (ACS), the American College of Obstetrics and Gynecology (ACOG) and the U.S. Preventive Services Task Force all changed their Pap screening recommendations, according to background information in the study. Both ACOG and the ACS recommended that when women over 30 years old had three consecutive Pap tests with normal results, those women could switch from annual tests to testing every two to three years. The task force recommended that all women be tested at least once every three years.

The ACS also recommended that a woman with three normal tests could stop screening at age 70 if she'd had no abnormal tests within 10 years. And, any woman with a life-limiting condition could stop Pap tests, according to the ACS. The task force recommended stopping screening at age 65 if past tests had been normal. ACOG felt there wasn't enough evidence to recommend a specific age to stop screening.

For the current study, Yabroff and her colleagues surveyed more than 1,200 primary care physicians, including 471 general or family practice doctors, 310 internal medicine physicians and 333 ob/gyns.

The physicians ranged in age from under 40 to over 60, and nearly two-thirds were male, according to the study. Most practiced in an urban location.

The researchers presented the physicians with questions about their screening practices, alongside four clinical vignettes describing a woman's age, along with her sexual and screening history. They then asked the doctors whether or not they would recommend screening for that woman. And, because of the differences in screening recommendations, the researchers created a composite measure to assess screening practices, according to Yabroff.

Some of the results:

  • About a third (32 percent) of physicians recommended a yearly Pap test for an 18-year-old with no sexual experience.
  • About 23 percent of doctors recommended an annual or biennial screen for a 66-year-old woman with advanced, inoperable lung cancer and three prior (consecutive) normal Pap results.
  • More than half (54.4 percent) recommended testing between every one to three years for a 71-year-old woman with three prior normal test results.
  • More than 44 percent of physicians recommended the Pap test every one to three years for a woman who had previously had her cervix removed for benign reasons.

Nearly 85 percent of the physicians surveyed described screening guidelines as "very influential." But, in practice, few actually followed the guidelines precisely. Overall, just 22 percent followed the guideline recommendations, the researchers found.

The variance in screening tended to be overuse of the test, the researchers said. The problem with overusing the test is that it may not be the best use of limited health care dollars, and more importantly could lead to additional unnecessary testing and worry for women.

Dr. Amy Chapman, an obstetrician/gynecologist at Scott and White Healthcare in Round Rock, Tex., said she was surprised by the study's findings. "In my experience, gynecologists really do follow the current recommendations from ACOG," she said.

She pointed out that those recommendations had recently changed again, which may be part of the reason physicians weren't following the guidelines consistently -- there may simply be a lag time between the changes and implementation, she said.

The bottom line, said Chapman, is that "patients should be their own advocate. Sit down with your doctor and ask what's the recommendation for you?"

More information

Learn more about cervical cancer and PAP screening from the American Cancer Society.



SOURCES: K. Robin Yabroff, Ph.D., epidemiologist, National Cancer Institute, Bethesda, Md.; Amy Chapman, M.D., department of obstetrics and gynecology, Scott and White Healthcare, Round Rock, Tex.; Nov. 3, 2009, Annals of Internal Medicine


'/>"/>
Copyright©2009 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. Heavy Patients Get Little Respect From Doctors
2. Study Forecasts More Young Doctors in Future
3. Tired Doctors More Prone to Errors
4. Renowned Southern California Doctors Emphasizing Early Detection During Breast Cancer Awareness Month
5. Toxic Chemicals Found in Doctors and Nurses
6. Many Doctors Still Dont Disclose Consulting Fees
7. New Palliative Medicine Fellowship Created to Train Pacific Northwest Doctors in End-of-Life Care
8. Doctors Don't Always Know Best: The Rise of e-Patients Offers a New Prescription for Resounding Health
9. Pediatrics: Doctors Must Find Better Ways to Talk To Parents about Childhood Obesity
10. Pelosi: Health Reform Will Provide Seniors Better Benefits, Guaranteed Access to Doctors, Extended Stability for Medicare
11. Doctors May Be Able to Predict Domestic Abuse
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... ... October 13, 2017 , ... ... certification process to promote standards of excellence for the field of eating disorders, ... March 22 – 25, 2018 in Orlando, Florida at the Omni Resort at ...
(Date:10/13/2017)... N.Y (PRWEB) , ... October 13, 2017 , ... Lori ... became a member of ElderCounsel, a national organization of elder law and special needs ... changing laws and rules. It also provides a forum to network with elder law ...
(Date:10/13/2017)... (PRWEB) , ... October 13, 2017 , ... The Visiting ... Day Market. Featuring a collection of specialty vendors and unique items from across the ... and quality-focused health and wellness services offered by the VNA. The boutique will ...
(Date:10/13/2017)... ... October 13, 2017 , ... Yisrayl Hawkins, Pastor and ... explains one of the most popular and least understood books in the Holy Scriptures, ... puzzling descriptions that have baffled scholars for centuries. Many have tossed it off as ...
(Date:10/13/2017)... ... ... “The Journey: From the Mountains to the Mission Field”: the story of a ... “The Journey: From the Mountains to the Mission Field” is the creation of published ... all ages and currently teaches a class of ladies at her church, which she ...
Breaking Medicine News(10 mins):
(Date:9/22/2017)... , Sept. 22, 2017  As the latest ... Senators Bill Cassidy (R-LA) and Lindsey ... notes that the medical device industry is in an ... device tax, the 2.3% excise tax on medical device ... they also want covered patients, increased visits and hospital ...
(Date:9/19/2017)... -- HistoSonics, Inc., a venture-backed medical device company developing a non-invasive, robotically assisted, platform therapy ... team developments today:   ... ... Tom Tefft ... Veteran medical device executive Josh Stopek , PhD, who has led R&D ...
(Date:9/18/2017)... KALAMAZOO, Mich. , Sept. 18, 2017 ... , and OptiMed Specialty Pharmacy of Kalamazoo, ... offer a strategic hub service that expedites and streamlines ... personal spirometer, Spiro PD 2.0, and wellness management services.  ... is a medical device used to measure lung function ...
Breaking Medicine Technology: