Specialty differences in primary care physician reports of papanicolaou test screening practices: a national survey, 2006 to 2007

Ann Intern Med. 2009 Nov 3;151(9):602-11. doi: 10.7326/0003-4819-151-9-200911030-00005.


Background: Cervical cancer screening guidelines were substantially revised in 2002 and 2003. Little information is available about primary care physicians' current Papanicolaou (Pap) test screening practices, including initiation, frequency, and stopping.

Objective: To assess current Pap test screening practices in the United States.

Design: Cross-sectional survey.

Setting: Nationally representative sample of physicians during 2006 to 2007.

Participants: 1212 primary care physicians.

Measurements: The survey included questions about physician and practice characteristics and recommendations for Pap screening presented as clinical vignettes describing women by age and by sexual and screening histories. A composite measure-guideline-consistent recommendations-was created by using responses to vignettes in which major guidelines were uniform.

Results: Most physicians reported providing Pap tests to their eligible patients (91.0% [95% CI, 89.0% to 92.6%]). Among Pap test providers (n = 1114), screening practices, including number of tests ordered or performed, use of patient reminder systems, and cytology method used, varied by physician specialty (P < 0.001). Although most Pap test providers reported that screening guidelines were very influential in their clinical practice, few had guideline-consistent recommendations for starting and stopping Pap screening across multiple vignettes (22.3% [CI, 19.9% to 25.0%]). Guideline-consistent recommendations varied by specialty (obstetrics/gynecology, 16.4%; internal medicine, 27.5%; and family or general practice, 21.1%). Compared with obstetricians/gynecologists, internal medicine specialists and family or general practice specialists were more likely to have guideline-consistent screening recommendations (odds ratio, 1.98 [CI, 1.22 to 3.23] and 1.45 [CI, 0.99 to 2.13], respectively) in multivariate analysis.

Limitation: Physician self-report may reflect idealized rather than actual practice.

Conclusion: Primary care physicians' recommendations for Pap test screening are not consistent with screening guidelines, reflecting overuse of screening. Implementation of effective interventions that focus on potentially modifiable physician and practice factors is needed to improve screening practice.

Primary funding source: National Cancer Institute, Centers for Disease Control and Prevention, and Agency for Healthcare Research and Quality.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cross-Sectional Studies
  • Early Detection of Cancer
  • Female
  • Guideline Adherence
  • Gynecology / statistics & numerical data
  • Humans
  • Internal Medicine / statistics & numerical data
  • Obstetrics / statistics & numerical data
  • Papanicolaou Test*
  • Physicians, Family / statistics & numerical data*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • United States
  • Uterine Cervical Neoplasms / diagnosis*
  • Vaginal Smears / statistics & numerical data*