Primary care physicians' recommendations for HPV DNA testing and attitudes toward the HPV vaccine

Background: The cervical cancer screening paradigm is shifting toward use of emerging technologies such as the HPV DNA test and HPV vaccine. These changes support policies against annual cervical cancer screening. This study assesses U.S. primary care physicians' (PCPs') recommendations for extending screening intervals that incorporate adjunct HPV DNA tests compared to Pap testing alone.

Methods: We surveyed a nationally-representative sample of 1,212 practicing PCPs in 2006-2007 (cooperation rate = 73.4%). Pap test recommendations were examined using 2 clinical vignettes of a 35-year old female with: 1) no new sexual partners and 3 consecutive negative Pap tests or 2) a negative Pap and negative HPV DNA test. Differences in recommendations were assessed by physician specialty.

Results: Approximately one third of PCPs recommended HPV DNA testing as an adjunct test for cervical cancer screening, with little variation noted by specialty. For a 35-year old with three negative Pap tests, 32.4% would conduct the next Pap test in 3 or more years. For a 35-year old with a negative HPV DNA test and a normal Pap test, 19.6% would conduct the next Pap test in 3 or more years. HPV DNA test recommendations varied, with responses evenly divided among no HPV testing, HPV testing at the same frequency as the Pap test, or unknown HPV testing frequency.

CONCLUSIONS: Over 80% of PCPs do not recommend extending the Pap screening interval to 3 years with adjunct HPV DNA testing. There is apparent resistance to extending the screening interval to 3 or more years