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Many doctors recommend next pap test too soon

Many doctors may be telling women to get another Pap test sooner than they need one, a new study suggests.

The study analyzed survey responses from more than 2,000 U.S. primary care physicians between 2006 and 2009. Doctors were asked when they would advise a woman between ages 30 and 60 to return for another Pap test (a screening test for cervical cancer) under different scenarios.

In most scenarios, doctors recommended that the woman return for another Pap test sooner than was advised by guidelines at the time.

For instance, in one scenario presented in the survey, a woman had a normal Pap test result and a negative test for human papillomavirus (HPV). Guidelines at the time said this woman could wait three years until her next Pap test.

But three-quarters of doctors surveyed said she should have another Pap less than three years later, with most saying she should return in one year.

The findings are troubling because more than 90 percent of U.S. women in this age group will have a normal Pap test and a negative HPV test, the researchers said. Moreover, newer guidelines now say women with a normal Pap test and negative HPV test could safely wait five years for their next test.

The new study did not examine why doctors often recommended the next Pap test too soon. But the phenomenon may be a "remnant of older way of thinking," on the part of both doctors and patients, said study researcher Dr. Mona Saraiya, of the Centers for Disease Control and Prevention. Older guidelines said that women should receive a Pap test every year.

Currently, the U.S. Preventive Services Task Force recommends that women start cervical cancer screening at age 21, and undergo screening every three years until age 65. At age 30, women can choose to lengthen the screening interval (up to five years) if they receive the HPV test as well.

The new results suggest that extending the amount of time in between screening tests can be a challenge, Saraiya said. In fact, studies on prostate cancer screening suggest that, once a screening recommendation is made, it's hard to "undo" it.

However, Saraiya said she is optimistic about the future of cervical cancer screening. While past screening guidelines from several major organizations differed, now most doctors' groups are in agreement, Saraiya said. This agreement could make it easier for doctors to extend the interval between screenings.

Screening for cervical cancer too frequently can cause harm because doctors may end up testing for and treating precancerous lesions that would have gone away on their own.

In a commentary accompanying the study, Dr. Michael L. LeFevre, of the University of Missouri, said that getting physicians to do less testing is often difficult, because physicians and the public have a tendency to believe that "more care is always better than less."

The current study did not assess doctors' adherence to the newer guidelines, so more research is needed to examine whether doctors' recommendations have changed in recent years.

The study is published online April 8 in the journal JAMA Internal Medicine.

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