Management of Abnormal Pap-HPV Tests Not Guideline Based

Most primary care physicians, including obstetrician-gynecologists, do not follow guidelines

TUESDAY, Nov. 23 (HealthDay News) -- When faced with managing even the most common abnormal Pap smear and human papillomavirus (HPV) testing results, most physicians, including obstetrician-gynecologists, do not adhere to current management guidelines, according to research published in the December issue of Obstetrics & Gynecology.

Zahava Berkowitz, of the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues conducted a survey of 950 primary care physicians familiar with HPV testing to assess the factors associated with various screening recommendations. The physicians were asked to make recommendation to a 35-year-old woman in each of two vignettes: discordant (normal Pap and positive HPV) or mildly abnormal (atypical squamous cells of undetermined significance Pap and negative HPV).

The researchers found that only 54.3 percent of physicians adhered to management guidelines by recommending both Pap and HPV testing in six to 12 months for the discordant test results; there was no significant difference in adherence by physician specialty. For the mildly abnormal results, obstetrician-gynecologists had a significantly higher percentage of guideline adherence (19.8 percent) compared with family and general practitioners (9.3 percent) and internists (11 percent).

"Our findings suggest that development and evaluation of interventions to improve adherence to management guidelines for the newer HPV DNA test, including educational efforts, reminder systems, and changes in test ordering systems will be important areas for additional research," the authors write.

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