Support for cervical cancer screening using Pap and HPV testing together continues to grow among health care providers and women
However, newly published survey reveals widening disagreement among HCPs around how often women should be screened
WASHINGTON, D.C., June 16, 2020 – New survey results exploring cervical cancer screening behaviors and attitudes show that a significant majority of health care providers (HCPs) and women consider co-testing using both the Pap test and HPV test together to be important to managing overall health. The percentage of responders agreeing with this statement has increased over the past five years, especially among HCPs.
In fact, 95 percent of HCPs today (versus 89 percent in 2015) see the value of the Pap test in screening for cervical cancer, while 88 percent of women (versus 87 percent in 2015) believe that cervical cancer screening is important in helping to manage overall health and well-being. In addition, 90 percent of women say they understand the value of the Pap test.
Because this is the second survey of more than 750 HCPs and 1,000 women conducted by the National Association of Nurse Practitioners in Women’s Health (NPWH) and HealthyWomen (HW) on this topic, it presents a unique opportunity to evaluate trends and shifts in practice since 2015. The new survey results were published this month in Women’s Healthcare: A Clinical Journal for Nurse Practitioners.
Confidence in the Pap test and co-testing remains widespread
Across the many topics surveyed related to cervical cancer screening, the majority of HCP respondents continue to support the 2012 consensus screening guidelines that call for Pap testing for women ages 21-29 and co-testing for women ages 30-65. Among HCPs today:
- 89 percent (versus 83 percent in 2015) believe co-testing is essential for patients’ health
- 92 percent say the Pap test is an effective tool for managing the risk of cervical cancer
- 81 percent say the Pap test itself is one of the primary reasons women get annual health check-ups in the first place, an 8-point percent increase from 73 percent in 2015
“The survey results reflect the ongoing confidence women and their HCPs have in the effectiveness and importance of cervical cancer screening,” said Aimee Chism Holland, DNP, WHN-BC, FNP-C, FAANP, Past-Chair of the Board of Directors for the National Association of Nurse Practitioners in Women’s Health . “They also demonstrate a growing reliance on co-testing with the Pap test plus the HPV test together as the gold standard for preventing cervical cancer.”
According to the survey, HCPs say they believe more than three-quarters of women (76%) are familiar with the Pap test and that almost two-thirds of women (64%) are aware that the Pap test and HPV test are collected in the same way, adding no extra time or frequency to their visits with their HCPs.
HPV testing alone continues to raise concerns among HCPs and their patients
“The survey results show just how ingrained the Pap test and co-testing are in managing women’s health,” said Dr. DaCarla Albright, member of HealthyWomen’s Women’s Health Advisory Council. “They demonstrate the growing desire among HCPs and women that both tests continue to be a part of the screening process.”
When it comes to screening with HPV alone (without the Pap test), the survey showed that both HCPs and women have serious concerns, with 61 percent of HCPs and 68 percent of women believing that eliminating the Pap test completely from frontline cervical cancer screening and only relying on HPV will have a negative impact on women’s health. In fact, fewer than 1 percent of HCPs screen using HPV alone, and 59 percent of women say they would actually be concerned if their HCP did not include the Pap test during screening.
When it comes to HPV-alone testing, HCPs fear the possibility of:
- more missed diagnoses (62%)
- more recommendations for colposcopies (61%)
- more positive diagnoses with no treatment options offered to patients (58%)
These concerns can cause anxiety and uncertainty for HCPs and their patients, especially knowing that most HPV infections will resolve on their own. This may be why 82 percent of HCPs say they plan to continue using the Pap test as part of their cervical screening practices for the foreseeable future.
Disagreement over how often women should be tested
HCP recommendations for how often women 30-65 should be tested and how often HCPs say women are tested differ widely, suggesting some uncertainty or disagreement between what may be best for women.
For example, 43 percent of HCPs recommend that women 30-65 who have been tested get retested every five years, yet HCPs say only 23 percent of these women actually do get tested every five years. In fact, HCPs say, 74 percent of women get tested more frequently, with 1 percent tested every four years, 31 percent tested every three years, 14 percent every two years, 27 percent every year and 1 percent every 6 months.
The cervical cancer screening conversation gap
Despite agreement across HCPs and women about the method of screening for cervical cancer, with both overwhelmingly preferring co-testing, the survey identified a critical gap between whether during a regular exam HCPs and women believe they even discuss cervical cancer.
While 76 percent of HCPs claim to discuss cervical cancer and HPV frequently as part of their routine exams (versus 64 percent in 2015), women’s perception is that they do not discuss these conditions as frequently as HCPs think, with only 27 percent saying they talk about it with their HCP most or all of the time. A quarter of women (25%) say they never discuss cervical cancer with their HCP, while 20 percent say they rarely do, all of which suggests that at each appointment, women need to ask specifically about what tests they need.
@HealthyWomen and @NPWH survey results exploring #cervicalcancer screening behaviors and attitudes shows HCPs and women consider co-testing using the Pap test and HPV test together to be important to managing overall health Tweet
The National Association of Nurse Practitioners in Women’s Health (NPWH) and HealthyWomen (HW) commissioned Cervical Cancer Today: A National Survey of Attitudes and Behaviors.
Women ages 25 to 65 years old nationwide (n= 1,000) were surveyed online. The survey oversampled African-American and Hispanic women. The survey took place from December 12, 2019 – December 29, 2019. The margin of error is plus or minus 2.2 percent in 95 out of 100 cases.
Health care providers (n=751) were surveyed online and included nurse practitioners, OB-GYNs and primary care physicians nationwide that are actively treating patients. The survey took place from December 17, 2019 – December 21, 2019. The margin of error is plus or minus 3.6 percent in 95 out of 100 cases.
HealthyWomen is the nation's leading independent, nonprofit health information source for women. Our mission is to educate, engage and inspire women, ages 35 to 64, to make informed health choices to live and age well. We engage with health care professionals, patient advocates, policy makers, NGOs and corporate partners to better inform our educational resources so that we can provide our audience with the most reliable, medically-accurate, balanced health information. For more than 30 years, women have turned to HealthyWomen for answers to their most personal health care questions. For more information, please visit www.HealthyWomen.org. Follow us on Facebook, Twitter, Instagram and LinkedIn.
About National Association of Nurse Practitioners in Women's Health (NPWH)
The National Association of Nurse Practitioners in Women's Health's mission is to ensure the provision of quality primary and specialty health care to women of all ages by women's health nurse practitioners and other women's health-focused advanced practice registered nurses. NPWH seeks to increase women's wellness and health outcomes, decrease health disparities affecting women, enhance women's access to and knowledge of health resources, and protect and promote women's rights to make choices regarding their health within the context of their personal beliefs. NPWH serves advanced practice registered nurses by providing education and resources to increase clinical competencies, advocating for health care policies that support women and APRNs, collaborating with interprofessional strategic partners, and fostering evidence-based practice in women's health through research. More information is available at www.npwh.org.
Albright DM, Rawlins S, Wu JS. Cervical cancer today: survey of screening behaviors and attitudes. Women’s Healthcare. 2020;8(3):41-46.