Investigators have uncovered that despite low adoption rates of the 2020 American Cancer Society (ACS) cervical cancer screening guidelines among physicians, a majority of them expressed willingness to utilize the recommendations under certain circumstances, according to a recent study published by Michel et al in Cancer.
Background
Nearly all cervical cancers are caused by the human papillomavirus (HPV). New evidence has led to dramatic changes in cervical cancer screening recommendations over the past 20 years. In 2020, the ACS released updated guidelines for cervical cancer screening, with the main changes to current practices involving the initiation of screening at the age of 25 instead of 21 and the use of primary HPV testing rather than cytology (Papanicolaou test) alone or in combination with HPV testing.
The purpose of clinical practice guidelines is to assist physicians in making evidence-based decisions, thereby improving the quality of care patients receive. Guidelines are often updated as new evidence becomes available; however, adoption into routine clinical practice may take up to two decades. As a result, understanding physician attitudes may be integral to facilitating practice changes.
“With the [U.S. Preventive Services Task Force] (USPSTF) in the process of updating screening recommendations, and self-collected HPV testing being considered for clinical use in the [United States], it is critical to understand [physician] attitudes toward the major changes proposed by the 2020 ACS guidelines,” explained senior study author Rebecca Perkins, MD, MSc, Professor of Obstetrics & Gynecology at the Boston University Chobanian & Avedisian School of Medicine and an obstetrician and gynecologist at the Boston Medical Center.
Study Methods and Results
In the recent study, the investigators performed in-depth interviews with 70 obstetricians and gynecologists, family medicine physicians, internal medicine physicians, and advanced practice providers regarding their attitudes toward the 2020 ACS cervical cancer screening guidelines.
Although few physicians have adopted the new guidelines, the investigators revealed that if provided with convincing evidence of the effectiveness of initiating screening at the age of 25 and using primary HPV testing and if the changes were endorsed by other professional societies such as the American College of Obstetricians and Gynecologists and the USPSTF, over 50% of them would be more willing to follow the recommendations.
They further identified barriers preventing adoption of the new guidelines, including logistical issues and concerns about missed disease detection.
Conclusions
“The implementation of new guidelines faces barriers related to [physicians], patients, health-care systems, and [the] sociopolitical context in which the medical care occurs such as beliefs about effectiveness, feasibility of practice change, laboratory availability, or insurance reimbursement,” concluded Dr. Perkins.
Disclosure: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.
