Human papillomavirus (HPV) vaccines prevent cervical pre-cancer lesion and can potentially reduce abnormal Papanicolaou (Pap) results among vaccinated females. However, current U.S. cervical screening guidelines recommend no change in screening initiation and frequency based on vaccination status. We examined providers’ practices and beliefs about HPV vaccination to evaluate their adherence to guidelines. We used 4-year data (2007–2010) from two nationally representative samples totaling 2119 primary-care providers from the Cervical Cancer Screening Supplement to the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). Providers in each survey were stratified to obstetrician/gynecologist (OB/GYNs) and non-OB/GYNs. Descriptive statistics and chi-square tests were performed to assess differences between providers’ types in each survey. Approximately 60% of providers believed that HPV vaccination will result in fewer abnormal Pap tests and fewer referrals to colposcopy and over 92% would not change their cervical cancer screening practices for fully vaccinated females. NAMCS OB/GYNs were more likely (p < 0.05) than non-OB/GYNs to rarely/never use the number of sexual partners to determine who gets the HPV vaccine (68.4% vs. 59.1%), more likely to recommend the vaccine to females with history of abnormal Pap (79.6% vs. 68.4%) and to females with a history of HPV positive test result (75.3% vs. 62.8%). Consistent with guidelines, most providers would not change cervical cancer screening practices based on patients’ vaccination history. However, some providers used inappropriate tests for making vaccination decisions. Improving HPV vaccine knowledge and recommendations for its use is warranted to implement a successful vaccine program.
by
James L. Klosky;
Melissa M. Hudson;
Yanjun Chen;
James A. Connelly;
Karen Wasilewski-Masker;
Can-Lan Sun;
Liton Francisco;
Laura Gustafson;
Kathryn M. Russell;
Gina Sabbatini;
Jessica S. Flynn;
Jocelyn M. York;
Anna R. Giuliano;
Leslie L. Robison;
F. Lennie Wong;
Smita Bhatia;
Wendy Landier
Purpose Cancer survivors are at high risk for human papillomavirus (HPV)-related morbidities; we estimated the prevalence of HPV vaccine initiation in cancer survivors versus the US population and examined predictors of noninitiation. Methods Participants included 982 cancer survivors (9 to 26 years of age; 1 to 5 years postcompletion of therapy); we assessed HPV vaccine initiation, sociodemographic and clinical characteristics, and vaccine-specific health beliefs; age-, sex-, and year-matched US population comparisons were from the National Immunization Survey-Teen and the National Health Interview Survey (2012-2015). Results Themean age at the time of the studywas 16.36 4.7 years; themean time off therapy was 2.7 6 1.2 years; participants were 55% male and 66% non-Hispanic white; 59% had leukemia/lymphoma. Vaccine initiation rates were significantly lower in cancer survivors versus the general population (23.8%; 95% CI, 20.6%to 27.0%v 40.5%; 95%CI, 40.2%to 40.7%; P , .001); survivors were more likely to be HPV vaccine-naive than general population peers (odds ratio [OR], 1.72; 95% CI, 1.41 to 2.09; P , .001). Initiation in adolescent survivors (ages 13 to 17 years) was 22.0% (95% CI, 17.3%to 26.7%), significantly lower than population peers (42.5%; 95%CI, 42.2% to 42.8%; P,.001). Initiation in young adult survivors and peers (ages 18 to 26 years) was comparably low (25.3%; 95% CI, 20.9% to 29.7% v 24.2%; 95% CI, 23.6% to 24.9%). Predictors of noninitiation included lack of provider recommendation (OR, 10.8; 95%CI, 6.5 to 18.0; P , .001), survivors' perceived lack of insurance coverage for HPV vaccine (OR, 6.6; 95% CI, 3.9 to 11.0; P,.001), male sex (OR, 2.9; 95%CI, 1.7 to 4.8; P,.001), endorsement of vaccine-related barriers (OR, 2.7; 95% CI, 1.6 to 4.6; P , .001), and younger age (9 to 12 years; OR, 3.7; 95% CI, 1.8-7.6; P , .001; comparison, 13 to 17 years). Conclusion HPV vaccine initiation rates in cancer survivors are low. Lack of provider recommendation and barriers to vaccine receipt should be targeted in vaccine promotion efforts.
Objective
To document Georgian physician’s knowledge, attitudes, and practices concerning HPV, Pap smear testing, and HPV vaccination, and to assess whether physician practice might change with additional education and training.
Methods
A cross-sectional study was conducted using a self-administered written survey of 288 physicians practicing in 7 healthcare institutions in Tbilisi, Rustavi, and Batumi, Georgia. Data were collected on demographics, conduct of and perceived barriers to Pap smear testing, knowledge about HPV and HPV vaccination, and willingness to receive education and training about HPV and cervical cancer. Univariate counts and proportions were calculated. Pap smear testing and barriers were compared across demographics using bivariate and Poisson regression with robust error variance methods.
Results
Overall, 54% of physicians never performed Pap smears; most reported testing was not their responsibility. Most (88%) obstetricians/gynecologists performed Pap smears. Younger physicians were more likely to perform Pap smears. Approximately 48% of physicians actively offered the HPV vaccine. Most physicians were receptive to increased education and training about HPV and cervical cancer.
Conclusion
Age-related differences in the conduct of and attitudes toward Pap smear testing exist among Georgian physicians. There is an opportunity to increase Pap smear testing and provide evidence-based HPV vaccine counseling in Georgia.