Regular Pap tests are vital, docs say

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Although medical guidelines have changed, most physicians opt for the 'better safe than sorry' approach when it comes to cervical cancer screenings among their patients, according to a government survey.

The research shows between 70- and 84 percent of physicians still recommend re-screening in three years or less when asked about a patient whose two most recent Papanicolaou tests, commonly known as Pap tests, were normal, and who had a negative result with HPV testing. Only 20 percent of physicians' answers were consistent with American Cancer Society (ACS) guidelines that recommend a 5-year interval between screenings for such patients.

The results come after analysis from a cervical cancer screening supplement to the National Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey between 2006 and 2009. Around 500 physicians participated in the surveys each year. About one-quarter of the respondents were ob/gyn specialists and the rest general-medicine providers.

The physicians were given several scenarios involving results of screening tests and were then asked to recommend the patient's next round of testing. They were given six choices: no follow-up needed, less than 6 months, 6 to less than 12 months, 1 year, 2 years, or 3 years or more. Between 65- and 78 percents of physicians said they would recommend 2 to 3 years between testing after two consecutive normal Pap tests with no HPV testing done, and 3 years with negative HPV results. Between 38- and 52 percent of physicians recommended only a year between screenings when patients had two consecutive normal Pap tests but positive HPV results. Fewer than 10 percent of physicians recommended a longer interval for re-screening.

Researchers say the results show the "physicians' desire to be proactive in protecting patients' health, driven by a strong cultural belief within the public that medical care can only do good, not harm, and that more care is always better than less."

ACSH s Dr. Gilbert Ross criticized this mindset, and was disappointed that it is so widespread: As a former practitioner, I certainly understand the urges to, on the one hand, have a satisfied patient, and on the other, to take no chances on missing something dangerous and preventable. But the evidence on pap test frequency is strong and has been repeated enough times, that the downside economically and health-wise for the patient, who will suffer from the detection of non-important abnormalities should convince doctors to take a chill on too-frequent testing.