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Common Abnormal Results of Pap and Human Papillomavirus Cotesting: What Physicians Are Recommending for Management

Berkowitz, Zahava MSPH, MSc; Saraiya, Mona MD, MPH; Benard, Vicki PhD; Yabroff, K. Robin PhD, MBA

doi: 10.1097/AOG.0b013e3181fae4ca
Original Research

OBJECTIVE: To evaluate the association between physician and practice characteristics and adherence to management guidelines to better understand the factors associated with different screening recommendations by primary care physicians.

METHODS: We used a cross-sectional nationally representative survey of 950 primary care physicians familiar with human papillomavirus (HPV) testing to assess adherence to management guidelines by analyzing responses to two clinical vignettes of a 35-year-old woman who had Pap and HPV tests results: 1) discordant (normal Pap and positive HPV) or 2) mildly abnormal (atypical squamous cells of undetermined significance Pap and negative HPV). Analyses included multivariable logistic regression.

RESULTS: For the discordant test results, 54.3% (95% confidence interval [CI] 51–57.6%) of physicians recommended both Pap and HPV testing in 6–12 months, adhering to management guidelines. For the mildly abnormal results, only 12.2% (95% CI 10–14.7%) had a guideline-adherent recommendation of Pap testing in 12 months with no HPV test. In multivariable analyses, no significant difference among physicians' specialties was observed for the discordant results. For the mildly abnormal results, physician specialty was associated with guideline adherence in which obstetrician–gynecologists had the highest percent of adherence (19.8%) compared with family and general practitioners (9.3%) and internists (11%) (P<.001).

CONCLUSION: Even for the most common abnormal results, many physicians reported recommendations that did not adhere to current management guidelines. Evidence-based interventions are needed to improve adherence to management guidelines for the newer HPV DNA test.


Even for the most common abnormal Pap and human papillomavirus cotesting results, many physicians report recommendations that do not adhere to current management guidelines.

From the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and the Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.

Funding for this study was provided by the National Cancer Institute (contract N02-PC-51308), Centers for Disease Control and Prevention (interagency agreement Y3-PC-6017-01), and the Agency for Healthcare Research and Quality (interagency agreement Y3-PC-5019-01 and Y3-PC-5019-02).

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Cancer Institute.

Corresponding author: Zahava Berkowitz, MSPH, MSc, Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop K-55, Atlanta, GA 30341; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.