Cervical cancer screening overused in some groups of women

November 25, 2013

SALT LAKE CITY-- For the past ten years, clinicians throughout the United States have been performing unnecessary Pap tests for cervical cancer screening in certain groups of women, according to a researcher from Huntsman Cancer Institute (HCI) at the University of Utah. The research results were published online in the Journal of the American Medical Association Internal Medicine today.

"Almost two-thirds (64.5%) of women who have had hysterectomies reported having recent Pap tests," said Deanna Kepka, PhD, MPH, co-author of the study, a Huntsman Cancer Institute (HCI) investigator, and assistant professor in the College of Nursing at the University of Utah. "And half (50.4%) of women over 65 who have no cervical cancer history also reported a recent Pap test. This represents 14 million women in the United States receiving an unnecessary procedure."

Because the risk of developing this slow-growing cancer is very small at such a late stage in life, Pap tests do not benefit women over age 65 who have no history of cervical cancer or pre-cancerous conditions. In addition, women who have had hysterectomies do not benefit from the test because nearly all of them no longer have a cervix, the specific target of this cancer screening test.

Since 2003, the U.S. Preventive Services Task Force (USPSTF) has recommended that Pap tests are unnecessary for these two groups of women. The USPSTF is an independent panel of experts in prevention and evidence-based medicine composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists).

The researchers examined data from the 2010 National Health Interview Survey, an annual health survey of representative samples of the entire United States population since 1957. The 2010 survey included the most recent cancer control supplement, which is included every three to five years.

"We knew there would be overuse of Pap tests, because the few studies of cervical cancer screening showed overuse ten years ago," said Kepka. "But we were shocked to see so little change over the past ten years.

"We're hoping to see better use of the tests over the next decade as changes in the health care infrastructure take place," she added. "Electronic medical records, health care provider reminder systems, decision support, and new strategies to improve the quality of care may promote guideline-consistent practices among clinicians."

Kepka's future work in this area includes a closer look at the demographics of women likely to receive unnecessary Pap tests, and an examination of how this information applies to Utah women.
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Co-authors of the study include Nancy Breen, PhD, of the National Cancer Institute, and Jessica B. King, MPH; Vicki B. Benard, PhD; and Mona Saraiya, MD, MPH, of the Centers for Disease Control and Prevention. Kepka performed this study on a post-doctoral fellowship funded by the National Cancer Institute. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institutes of Health or the Centers for Disease Control and Prevention.

The mission of Huntsman Cancer Institute (HCI) at The University of Utah is to understand cancer from its beginnings, to use that knowledge in the creation and improvement of cancer treatments, to relieve the suffering of cancer patients, and to provide education about cancer risk, prevention, and care. HCI is a National Cancer Institute-designated cancer center, which means that it meets the highest national standards for world-class, state-of-the-art programs in multidisciplinary cancer research and receives support for its scientific endeavors. HCI is also a member of the National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of the world's leading cancer centers dedicated to improving the quality and effectiveness of care provided to patients with cancer. For more information about HCI, please visit http://www.huntsmancancer.org.

University of Utah Health Sciences

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