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Cooper C.P.,Soltera Center for Cancer Prevention and Control | Saraiya M.,U.S. Center for Disease Control and Prevention
American Journal of Preventive Medicine

Background: Some primary care physicians choose not to provide cervical cancer screening. Purpose: To investigate the characteristics and screening beliefs of family practitioners and internists who treat adult women in outpatient settings but perform no routine Pap tests. Methods: A survey of U.S. primary care physicians (N=892) was conducted and analyzed in 2012. Results: Participants who performed no Pap tests during a typical month (17.2% of family practitioners and 44.3% of internists) generally reported that they referred patients to gynecologists for cervical cancer screening. The most significant predictor of Pap test non-provision was agreement that patients are best served by having Pap tests performed by gynecologists (AOR=8.80, 95% CI=5.58, 13.88, p<0.001). Conclusions: The perception that patients benefit from cervical cancer screening administered by gynecologists may deter screening in primary care settings, resulting in missed opportunities to offer screening to women who are never or rarely screened. © 2014 American Journal of Preventive Medicine. All rights reserved. Source

Cooper C.P.,Soltera Center for Cancer Prevention and Control | Saraiya M.,U.S. Center for Disease Control and Prevention | Sawaya G.F.,University of California at San Francisco
American Journal of Preventive Medicine

Introduction Current U.S. cervical cancer screening guidelines recommend a 3- or 5-year screening interval depending on age and screening modality. However, many women continue to be screened annually. The purpose of this study is to investigate U.S. women's self-reported frequency of cervical cancer screening, acceptance of an extended screening interval (once every 3-5 years), and preferred screening options. Methods Data from a 2012 web-based survey of U.S. women aged ≥18 years who had not undergone a hysterectomy or been diagnosed with cervical cancer (N=1,380) were analyzed in 2014. Logistic regression models of extended screening interval use, acceptance, and preference were developed. Results Annual Pap testing was the most widely used (48.5%), accepted (61.0%), and preferred (51.1%) screening option. More than one third of respondents (34.4%) indicated that an extended screening interval would be acceptable, but only 6.3% reported that they were currently screened on an extended interval. Women who preferred an extended screening interval (32.9% of those willing to accept regular screening) were more likely to report no primary care visits during the last 12 months (AOR=2.05, p<0.003), no history of abnormal Pap test results (AOR=1.71, p=0.013), and that their last Pap test was performed by an internist/family practitioner rather than an obstetrician-gynecologist (AOR=2.03, p<0.001). Conclusions U.S. women's acceptance of and preference for an extended cervical cancer screening interval appears to be more widespread than utilization. Strategies to educate women about the reasoning behind recommendations for less-than-annual testing and to foster informed preferences should be devised and evaluated. Source

Cooper C.P.,Soltera Center for Cancer Prevention and Control | Gelb C.A.,Centers for Disease Control and Prevention | Hawkins N.A.,Centers for Disease Control and Prevention
Preventive Medicine

Objective: Colorectal cancer screening has been widely promoted in the United States. We investigated the association between reported exposure to screening information during the past year and screening participation and knowledge. Method: Data from the 2012 HealthStyles Fall survey of U.S. adults were examined using adjusted logistic regression to examine the frequency of exposure to screening information as a predictor of screening participation and knowledge; analyses were limited to participants aged ≥. 50. years with no history of colorectal cancer or polyps (N. = 1714). Results: Nearly half of the participants (44.9%) reported exposure to colorectal cancer screening information during the previous year. The most common sources of screening information were news reports, advertisements, and health care providers. Screening participation and knowledge consistently increased with the reported frequency of exposure to screening information, and these associations generally persisted when demographic variables were controlled. Compared with unexposed participants, significant gains in screening participation were associated with exposure to screening information 2-3 times (Adj. OR. = 1.84, p. = 0.001), 4-9 times (Adj. OR. = 2.00, p. = 0.001), and ≥. 10 times (Adj. OR. = 3.03, p. <. 0.001) in the adjusted model. Conclusions: Increasing public exposure to screening promotion messages may augment screening participation and knowledge. © 2013. Source

Cooper C.P.,Soltera Center for Cancer Prevention and Control | Saraiya M.,Centers for Disease Control and Prevention
Preventive Medicine

Background: The human papillomavirus (HPV) test, administered alone without the Papanicolaou (Pap) test, was recently recognized as a cervical cancer screening option in the United States by the Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology, and the Food and Drug Administration has approved an HPV test for primary screening. Methods: Surveys of US internists, family practitioners, nurse practitioners, and obstetrician-gynecologists were conducted in 2009 and 2012 to investigate providers' perceptions of the effectiveness of the HPV test administered alone as a population-based screening modality (2009: N= 1040, 141-494 per provider group; 2012: N= 1039, 155-435 per provider group). Results: The majority in each provider group agreed that the HPV test administered alone is an effective screening modality in 2009 (75.3%-86.1%) and 2012 (79.5%-91.8%), and agreement rose significantly during this time period among family practitioners (χ2=15.26, df=1, p<0.001) and nurse practitioners (χ2=4.53, df=1, p=0.033). Conclusions: Agreement that the HPV test administered alone is an effective cervical cancer screening modality was widespread among providers in both 2009 and 2012, however implementation of guidelines for screening with the HPV test may be influenced by many other factors including reimbursement and patient preferences. © 2015. Source

Stormo A.R.,CDC | Cooper C.P.,Soltera Center for Cancer Prevention and Control | Hawkins N.A.,CDC | Saraiya M.,CDC
Preventive Medicine

Objective: To examine physicians' beliefs about the pelvic examination and identify physician characteristics associated with routine use of this procedure in the United States. Methods: A total of 1250 United States family/general practitioners, internists, and obstetrician/gynecologists who participated in the 2009 DocStyles survey completed questions on beliefs regarding the utility of routine pelvic examinations for cancer screening. The survey also asked participants how often they performed this procedure as part of a well-woman exam, to screen for ovarian and other gynecologic cancers, to screen for sexually transmitted infections, and as a prerequisite for prescribing hormonal contraception. Results: A total of 68.0% of obstetrician/gynecologists, 39.2% of family/general practitioners, and 18.7% of internists reported routinely performing pelvic examinations for all the purposes examined (< 0.001). Adjusted analyses revealed that the factors most strongly associated with use of pelvic examinations for all purposes were being an obstetrician/gynecologist (odds ratio 8.5; 95% confidence interval 5.8-12.6) and believing that this procedure is useful to screen for gynecologic cancers (odds ratio 3.8; 95% confidence interval 2.6-5.5). Conclusion: Misconceptions about the utility of pelvic examinations to screen for gynecologic cancers are common. More effective strategies to change physicians' beliefs regarding the value of performing pelvic examinations in asymptomatic women are needed. © 2012. Source

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