Clinicians have concerns related to the 2012 Cervical Cancer Screening Guidelines. Clinicians are beginning to understand, as we have had so much information regarding HPV and Pap testing - and with advent of HPV vaccination - that there is greater awareness of HPV among the population.
Clinicians are concerned. When do I discuss HPV? How will I have time to talk with my patients? How can I get information to my patients so they understand why they won’t need to return for a Pap test every year? We have taught patients so well: a Pap every year. Now we need to change that message that has been so ingrained in our patients’ minds. For instance:
1. Time needed to discuss HPV: Clinicians may say, “I do not have time to discuss these changes and HPV testing with their patients.” But the messages are clear, and can truly be delivered in 3 minutes or less.
2. Discomfort delivering message:
- It can be uncomfortable dealing with monogamous patients that get an HPV positive result, and in turn assume their partner has been unfaithful.
- Clinicians worry that they will lose patients. If the Pap is the end-all and be-all of an annual exam, what will women do when they learn that they do not need a Pap every year?
3. Trusting the new Screening Guidelines: It’s very important for clinicians to understand and get comfortable with the new Guidelines.
- That is, if you understand natural history of HPV and oncogenesis, and the reassurance of a high negative predictive value tied of a Pap-negative/HPV-negative result, you will be comfortable with the 5-year interval to the next screen. This knowledge will help you more effectively communicate that information to your patients.
- Testing intervals: How about the patient who was negative on her HPV, negative on her Pap, but she has had a new partner? What do we know about HPV and new infections?
- We know that most everybody is infected by HPV, especially young women.
- We know that the mean time to clearance of an HPV infection is 8-9 months, and the majority of infections clear by 24
months. Given this information, even if there is a new HPV infection in a woman, we would want her to have time to clear
that infection.
- There is also the reassurance that even if precancerous lesions develop, there is about a 10 to 15 year natural history for
invasive cancer to develop.
- In sum, we want clinicians to be comfortable and familiar with the information that allows them to educate their patients, including longer screening intervals.
