TY - JOUR
T1 - Assessing Physician Adherence to Guidelines for CervicalCancer Screening and Management of AbnormalScreening Results
AU - Min, Caroline J.
AU - Massad, L. Stewart
AU - Dick, Rebecca
AU - Powell, Matthew A.
AU - Kuroki, Lindsay M.
N1 - Funding Information:
1Department of Obstetrics and Gynecology, Washington University School of Medicine. St. Louis, MO; 2Division of Gynecologic Oncology, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St. Louis, MO Reprint requests to: Lindsay M. Kuroki, MD, MSCI, Department of Obstetrics & Gynecology, 660 S. Euclid Ave, Mailstop 8064-37-905, St. Louis, MO 63110. E-mail: kurokil@wustl.edu The authors have declared they have no conflicts of interest. Supported by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) under Award Number KL2TR002346. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH (KL2 scholar, L.M.K.). The institutional review board approval was obtained on February 21, 2019, by the Washington University's Human Research Protection Office (IRB Project #201810017). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jlgtd.com). © 2020, ASCCP DOI: 10.1097/LGT.0000000000000558
Publisher Copyright:
© Lippincott Williams & Wilkins.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Objective The aim of the study was to survey obstetrician-gynecologists' cervical cancer screening practices and management of cervical abnormalities to ascertain adherence to guidelines. Methods 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. Results 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). Conclusions 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.
AB - Objective The aim of the study was to survey obstetrician-gynecologists' cervical cancer screening practices and management of cervical abnormalities to ascertain adherence to guidelines. Methods 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. Results 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). Conclusions 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.
KW - cancer screening
KW - cervical cancer
KW - nonadherence to guidelines
KW - overtreatment
UR - http://www.scopus.com/inward/record.url?scp=85091807455&partnerID=8YFLogxK
U2 - 10.1097/LGT.0000000000000558
DO - 10.1097/LGT.0000000000000558
M3 - Article
C2 - 32976292
AN - SCOPUS:85091807455
SN - 1089-2591
VL - 24
SP - 337
EP - 342
JO - Journal of lower genital tract disease
JF - Journal of lower genital tract disease
IS - 4
ER -