Doctors Overprescribing the Pap Test

Many ignore guidelines, recommend screening to women at low risk, survey shows

By Serena Gordon
HealthDay Reporter

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MONDAY, Nov. 2 (HealthDay News) -- In 2002 and 2003, screening guidelines for the cervical cancer-detecting Pap test were changed significantly, yet fewer than one-third of U.S. primary care physicians follow those guidelines, according to a recent study.

Many overprescribe the screen, telling researchers that they would recommend it to virgins (most cervical cancers arise from a sexually transmitted virus), women with inoperable cancers and even women who have had their cervix surgically removed.

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Overall, the study found that only 28 percent of internal medicine doctors, 21 percent of general practitioners and 16 percent of obstetricians/gynecologists use the Pap screen in the recommended way.

"We conducted a nationally representative survey of primary care physicians in the U.S., and found that the majority of physicians do not have guideline-consistent screening recommendations," said the study's lead author, K. Robin Yabroff, an epidemiologist at the National Cancer Institute in Bethesda, Md.

However, the researchers also found that the physicians said "guidelines were influential in their practice," according to Yabroff.

The findings are published in the Nov. 3 issue of the Annals of Internal Medicine.

The Papanicolaou (Pap) test screening is used to detect early changes in cervical cells that might indicate cancer. In the past, it was recommended that sexually active women have the test every year.

But, in 2002 and 2003, the American Cancer Society (ACS), the American College of Obstetrics and Gynecology (ACOG) and the U.S. Preventive Services Task Force all changed their Pap screening recommendations, according to background information in the study. Both ACOG and the ACS recommended that when women over 30 years old had three consecutive Pap tests with normal results, those women could switch from annual tests to testing every two to three years. The task force recommended that all women be tested at least once every three years.

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