title: Providers' practice, recommendations and beliefs about HPV vaccination and their adherence to guidelines about the use of HPV testing, 2007 to 2010.
abstract: Human papillomavirus (HPV) vaccines prevent cervical pre-cancer lesion and can potentially reduce abnormal Papanicolaou (Pap) results among vaccinated females. However, current U.S. cervical screening guidelines recommend no change in screening initiation and frequency based on vaccination status. We examined providers' practices and beliefs about HPV vaccination to evaluate their adherence to guidelines. We used 4-year data (2007-2010) from two nationally representative samples totaling 2119 primary-care providers from the Cervical Cancer Screening Supplement to the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). Providers in each survey were stratified to obstetrician/gynecologist (OB/GYNs) and non-OB/GYNs. Descriptive statistics and chi-square tests were performed to assess differences between providers' types in each survey. Approximately 60% of providers believed that HPV vaccination will result in fewer abnormal Pap tests and fewer referrals to colposcopy and over 92% would not change their cervical cancer screening practices for fully vaccinated females. NAMCS OB/GYNs were more likely (p<0.05) than non-OB/GYNs to rarely/never use the number of sexual partners to determine who gets the HPV vaccine (68.4% vs. 59.1%), more likely to recommend the vaccine to females with history of abnormal Pap (79.6% vs. 68.4%) and to females with a history of HPV positive test result (75.3% vs. 62.8%). Consistent with guidelines, most providers would not change cervical cancer screening practices based on patients' vaccination history. However, some providers used inappropriate tests for making vaccination decisions. Improving HPV vaccine knowledge and recommendations for its use is warranted to implement a successful vaccine program.
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: zab3@cdc.gov.
authors.forename: Z
authors.initials: Z
authors.lastname: Berkowitz
authors.affiliation: Emory University, School of Medicine, Dept. of Obstetrics and Gynecology, Atlanta, GA, USA.
authors.forename: N
authors.initials: N
authors.lastname: Nair
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Saraiya
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014611:Vaccination / Q000706:statistics & numerical data*; D014626:Vaginal Smears / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer screening; HPV test use; HPV vaccination impact; NAMCS and MHAMCS; Vaccina