Primary care clinicians reported that they would recommend cervical cancer screening more frequently, despite guidelines that recommend screening every three years for low-risk women, according to a report published in Archives of Internal Medicine. And researchers found that adding a screening test for human papillomavirus (HPV) doesn't make clinicians adhere to screening guidelines, but they may be less likely to extend screening intervals.

Physicians may need to get used to the newer guidelines that recommend less frequent screenings, said Mona Saraiya, author and medical epidemiologist for the Centers for Disease Control and Prevention's cancer prevention and control division.

"Providers and women are used to annual testing," Saraiya told DOTmed News. "Moving toward screening later and less often; it takes awhile for providers to feel comfortable.

The American Cancer Society (ACS) and the American Congress of Obstetricians and Gynecologists (ACOG) recently changed their annual screening recommendations for women age 30 and older to have a screening every three years, if they've had three consecutive normal Pap tests.

David Soper, professor of obstetrics and gynecology at the Medical University of South Carolina, said he was not surprised by the study's findings.

"The guidelines just came out, and it takes a while for guidelines to filter out from the societies that end up recommending them to actual practice," he said. "I think this takes several years."

Also recommended for women age 30 and older is testing for HPV, which is the virus that can cause cervical cancer. This test can be done simultaneously with a conventional Pap test, explains Saraiya. Generally, the test is used as a follow-up test if Pap results are abnormal, but lately it has been used as a screening test.

Saraiya and her team of researchers, including the National Cancer Institute (NCI) surveyed 1,212 primary care physicians, of which 950 performed Pap tests and had recommended the HPV test for their patients. Clinicians surveyed included general practitioners, family practitioners, obstetrician-gynecologists and general internists.

Saraiya found that non-OB/GYN clinicians were more likely to extend screening intervals and use solely a Pap test. And physicians who were part of a large practice were also more comfortable in extending screening intervals.

The survey revealed that for a 35-year-old woman with no new sex partners in the last five years and three normal Pap test results, 31.8 percent of clinicians said they would recommend the next Pap test in three years, and 31.8 percent would recommend the Pap test in one year. But for a 35-year-old woman with one normal Pap test and a normal HPV test, 19 percent of clinicians reported that they would extend the screening intervals, while 60.1 percent would recommend annual testing.

"To me, this indicates that those providers are unfamiliar with the use of the HPV test as part of the screening," said Saraiya. "They need more information on how to use the HPV test."

Because a negative HPV test indicates a very low chance of high-grade diseases, it is a good test for reassurance, Saraiya said.

Better safe than sorry?

In many cases, being thorough and cautious can be a good thing. But when it comes to cervical cancer screening, unnecessary testing is expensive and could lead to health hazards.

The HPV test is about $50, plus a $10 to $20 Pap test, which adds up annually, said Saraiya.

"Cost effectiveness models suggest that the practice patterns we found in our study are likely to increase costs with little improvement in reducing cervical cancer incidence and increasing survival," according to the report.

But not only is unnecessary testing expensive, it can be harmful to a woman's health. Some tests may result in false positives, causing undue anxiety. And follow-up tests can lead to problems, including adverse birth outcomes in young women.

The risk of cervical cancer goes up at age 30, which is why testing is recommended more frequently, but not necessarily annually once a woman reaches 30. Abnormal cells in younger women can, in most cases, right themselves.

"HPV testing is not recommended as a screening tool in women under 30," said Saraiya. "Most likely, women [under 30] will test positive for HPV, but it will disappear in a year."

Soper pointed out that the best way for providers to confidently follow the recommendations is to be well-read and understand that over-testing can be harmful, and why most women won't need annual screening.

Saraiya said she and her team want women and clinicians to take away from this report that annual screening in low-risk women -- normal Pap results and under age 30 -- can do more harm than good, and the tests should be used appropriately.

"Over-screening or more tests carry risks. They're not always a reassurance," she said. "Women should feel comfortable asking providers key questions related to Pap and HPV testing."