CDC’s Cervical Cancer Study

Cervical cancer is most often caused by a genital human papillomavirus (HPV) infection. HPV infection is common and often goes away on its own. Persistent HPV infections, however, can cause changes to cervical cells that sometimes turn into cervical cancer if not treated. Each year in the United States, about 12,000 women are diagnosed with cervical cancer, and about 4,000 die of the disease.

Two tests can help prevent cervical cancer: the Pap test and the HPV test. The Pap test looks for cell changes on the cervix that may become cancer if they are not treated appropriately. The HPV test looks for the types of HPV that are most likely to cause cancer in cervical cells.

Current guidelines [PDF-171KB] recommend that all women should have a Pap test every three years beginning at age 21. Women aged 30 to 65 years may choose instead to get both a Pap test and an HPV test at the same time every five years. This is called co-testing.

Even though screening every three or five years is recommended, many doctors still screen their patients for cervical cancer every year. As part of CDC’s Cervical Cancer (Cx3) Study, we surveyed a sample of both health care providers and patients at federally qualified health centers during the time period of 2009 and 2010 about their practices, beliefs, and barriers to using the co-test and extending cervical cancer screening intervals for women between 30 and 60 years old.

Results

Providers

• Only 39% of providers reported regular use of the co-test, and 25% would recommend a guideline-consistent interval for women with normal co-test results.
• Barriers to extending screening intervals included concerns about patients not returning every year for other screening tests (77%), perceived concerns by patients about missing cancer (62%), and liability (52%).
• Screening recommendations were associated with positive beliefs regarding longer screening intervals. Professional journals and organizations can disseminate screening interval messages to promote evidence-based screening.
• As HPV testing plays a more prominent role in cervical cancer screening, more attention should be given to communication between providers and patients about the benefits and harms of different screening options.

Patients

• 61% of patients reported annual Pap testing, and misunderstandings about the Pap test were common. More than half of them believed a Pap test could find vaginal, yeast, and sexually transmitted infections.
• The majority of patients (57%) indicated that they would not wait three years to be screened, even if it was recommended by their provider; this is primarily due to low levels of knowledge about Pap testing.
• Education for both patients and providers about the possible harms of getting screened too frequently and false positives may be needed to balance barriers to extending screening intervals.

Citations

Lin L, Benard VB, Greek A, Hawkins NA, Roland KB, Saraiya M. Racial and ethnic differences in human papillomavirus positivity and risk factors among low-income women in Federally Qualified Health Centers in the United States. Preventive Medicine 2015;81:258–261.

Lin L, Benard VB, Greek A, Roland KB, Hawkins NA, Saraiya M. Communication practices about HPV testing among providers in Federally Qualified Health Centers. Preventive Medicine Reports 2015;2:436–439.

Roland KB, Greek A, Hawkins NA, Lin L, Benard VB. Provider beliefs associated with cervical cancer screening interval recommendations: A pilot study in Federally Qualified Health Centers. Preventive Medicine Reports 2015;2:444–447.

Saraiya M, Benard VB, Greek A, Steinau M, Patel S, Massad LS, Sawaya GF, Unger ER. Type-specific HPV and Pap test results among low-income, underserved women: providing insights into management strategies. American Journal of Obstetrics and Gynecology 2014;211(4):354.e1–e6.

Roland KB, Benard VB, Greek A, Hawkins NA, Saraiya M. Primary care providers’ human papillomavirus vaccine recommendations for the medically underserved: a pilot study in U.S. Federally Qualified Health Centers. Vaccine 2014;32(42):5432–5435.

Benard VB, Saraiya M, Greek A, Hawkins NA, Roland KB, Manninen D, Ekwueme DU, Miller JW, Unger ER. Overview of the CDC Cervical Cancer (Cx3) Study: an educational intervention of HPV testing for cervical cancer screening. Journal of Women’s Health 2013;23(3):197–203.

Hawkins NA, Benard VB, Greek A, Roland KB, Manninen D, Saraiya M. Patient knowledge and beliefs as barriers to extending cervical cancer screening intervals in Federally Qualified Health Centers. Preventive Medicine 2013;57(5):641–645.

Roland KB, Benard VB, Greek A, Hawkins NA, Manninen D, Saraiya M. Primary care provider practices and beliefs related to cervical cancer screening with the HPV test in Federally Qualified Health Centers. Preventive Medicine 2013;57(5):419–425.