Cervical cancer screening and management practices among providers in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

Abstract

BACKGROUND. This study was conducted to describe clinicians serving women in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) with regard to demographic and practice characteristics and their usual practices in cervical cancer screening and abnormal cytology management, as well as human papillomavirus (HPV) test use. METHODS. The authors analyzed data from a nationally representative survey conducted in 2004 of providers practicing 7 specialties that commonly offer cervical cancer screening. The program providers were compared with nonprogram providers. RESULTS. Program providers were found to be significantly more likely than nonprogram providers to be midlevel providers and to serve low‐income, racial/ethnic minorities who are insured by Medicaid. In addition, they had significantly more patients with abnormal Papanicolaou tests and were more likely to offer onsite colposcopy (57% vs 40%). Program providers were less likely to use liquid‐based cytology (LBC) as their sole method for cytology. Approximately 20% of program and nonprogram providers used HPV DNA testing as an adjunct to screening cytology and two‐thirds used HPV tests to manage patients with abnormal cytology results. However, many also used HPV testing for reasons not approved by the U.S. Food and Drug Administration (FDA), such as for screening women age <30 years. CONCLUSIONS. As of mid‐2004, program providers served racially and ethnically diverse, low‐income patients who are at high risk for cervical cancer compared with nonprogram providers, as intended by this program. Because many providers offered on‐site colposcopy, used LBC, and used HPV tests for patients with abnormal cytology results, they are well equipped to reduce the risk of cervical cancer. Many program providers used the HPV test for reasons that were not approved of by the FDA or reimbursed by the NBCCEDP. The results of this survey have informed training materials for program providers, reimbursement policies for LBC and HPV tests, and interventions to discourage inappropriate HPV testing. (See editorial on pages 000–000, this issue.) Cancer 2007. Published 2007 by the American Cancer Society.