A newly released survey, Cervical Cancer Today: A National Survey of Attitudes and Behaviors, paints a picture of women and their healthcare providers as resistant to changes in one of the most successful cancer prevention programs in U.S. history: cervical cancer screening.
The survey, conducted jointly by the National Association of Nurse Practitioners in Women's Health (NPWH) and HealthyWomen (HW), explored the attitudes and decisions in the exam room of more than 2,000 women and 750 healthcare providers nationwide.
Women and Healthcare Providers Rely on the Pap Test
For decades, Pap tests have been a central feature of the annual well-woman's exam, greatly reducing deaths from cervical cancer since the 1950s. Since the 1990s, understanding of cervical cancer has grown to include the role of HPV, some strains of which are now known to cause cervical cancer. The subject of cervical cancer screening has been under scrutiny in recent years, however, as experts grapple with when and how to best utilize Pap and HPV testing, whether individually or simultaneously (i.e., co-testing). The 2012 consensus guidelines recommend screening with the Pap test only or co-testing at various intervals based on a patient's age and other factors.
Among the themes in the survey data is an overwhelming preference for routine cervical cancer screening and for continued use of the Pap test. In fact, 91 percent of healthcare providers say they believe the Pap test should remain part of frontline screening for the foreseeable future. Their perspective is echoed by women, 90 percent of whom believe that the Pap test is important to their overall health and well-being. This is even more true among African-American (96 percent) and Hispanic (91 percent) women, populations that have the highest rates of cervical cancer.
The Benefit of Pap and HPV Tests
According to the survey, co-testing has been widely adopted by healthcare providers, especially among nurse practitioners and OB-GYNs, 83 percent of whom say it adds value to their patients' health. Further, 74 percent of healthcare providers believe the majority of their patients would be most comfortable with receiving both Pap and HPV tests versus either alone (12 percent and 2 percent, respectively).
"The Pap and HPV tests each contribute useful and distinct information for evaluating cervical cancer risk," says Gay Johnson, CEO of the National Association of Nurse Practitioners in Women's Health. "Current practices and the preferences of women and their healthcare providers should be considered when evolving guidelines for cervical cancer screening."
Concern with Time between Tests
Controversy concerning extending the cervical cancer screening interval continues within the healthcare community. The Cervical Cancer Today survey shows that the idea of extending testing intervals to three or five years triggers deep concerns for both women and their healthcare providers. The majority of healthcare providers said they prefer to see their patients every one to three years for cervical cancer screening. Their patients are aligned, with 76 percent of women reporting they are screened every one to three years.
The majority (nearly 70 percent) of women indicate they would be concerned about a five-year screening interval. African-American and Hispanic women were even more concerned (82 percent and 74 percent, respectively). Healthcare providers concur, with more than half of nurse practitioners and OB-GYNs saying they believe the screening of women ages 30 to 65 every three to five years will have a negative impact on women's health.
"The data in this survey show that women and their healthcare providers truly value regular cervical cancer screening and are reluctant to change how often tests that we know to be successful are used," says Beth Battaglino, RN, president and CEO of HealthyWomen. "Women should have these important conversations about cervical cancer screening with their healthcare providers to determine the best approach for their individual health needs."
More Understanding of HPV Needed
Survey respondents showed lower levels of understanding surrounding HPV, which, coupled with their overwhelming trust in the Pap test, may contribute to their unwillingness to embrace changes in screening patterns.
Just under half of women surveyed (48 percent) understood HPV infection can cause cervical cancer and only 34 percent of women say they are familiar with the HPV test. Healthcare providers estimated this confusion to be even deeper, with only 26 percent of healthcare providers saying they believe their patients are aware that HPV can cause cervical cancer.
This lack of understanding has important clinical implications. Only 15 percent of women reported knowing that HPV infections can resolve on their own. In fact, the vast majority of HPV infections will go away without any treatment or intervention of any kind, an understanding that is crucial to avoiding unnecessary tests and treatments for otherwise harmless infections.
Another notable finding in the survey was the increased level of anxiety reported by 41 percent of women in response to an HPV infection. "There is much confusion and misunderstanding about HPV, and that confusion may prevent women from making informed decisions about how to manage these types of infections," says Johnson, of the National Association of Nurse Practitioners in Women's Health. The fact is, with as many as 80 percent of women and men becoming infected at some point in their lives, HPV is extremely common, and the vast majority of these infections will clear up on their own. HPV can be effectively monitored and, if necessary, treated to prevent cancer.
"Healthcare providers need to help women understand the significance - or lack thereof - of an HPV infection," says Battaglino, of HealthyWomen. "Women need comprehensive information about the meaning of both HPV and Pap tests when deciding how to protect themselves from cervical cancer."