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US physicians’ intentions regarding impact of human papillomavirus vaccine on cervical cancer screening

Charlene Wong A C , Zahava Berkowitz A , Mona Saraiya A , Louise Wideroff B and Vicki B. Benard A

A Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop K-55, Atlanta, GA 30341, USA.

B National Cancer Institute, 6001 Executive Blvd., Suite 5153 MSC 9589, Bethesda, MD 20892-9589, USA.

C Corresponding author. Email:

Sexual Health 7(3) 338-345
Submitted: 29 October 2009  Accepted: 28 January 2010   Published: 19 August 2010


Background: US cervical cancer screening recommendations have not changed since the human papillomavirus (HPV) vaccine introduction in 2006, but epidemiological and cost-effectiveness studies indicate that recommendations will need to change for fully vaccinated women. We evaluated physician intentions regarding HPV vaccine’s impact on future screening. Methods: A nationally representative sample of 1212 primary care physicians was surveyed in 2006–2007 (response rate: 67.5%). Our study included 1114 physicians who provided Pap testing. Questions covered Pap test screening practices and intentions regarding HPV vaccine’s impact on screening. Distribution differences were assessed using χ2 statistics; multivariate analyses were performed. Results: Overall, 40.7% (95% confidence interval (CI): 37.6–43.8%) of physicians agreed that the HPV vaccine will affect screening initiation, and 38.2% (35.0–41.5%) agreed that vaccination will affect screening frequency. Significant differences in responses were found by specialty; internists were more likely to agree that vaccination would impact screening than other specialties. Belief in the effectiveness of new screening technologies was associated with intention to change screening initiation (odds ratio (OR) = 1.66 (1.20–2.31)) and frequency (OR = 1.99 (1.40–2.83)). Adherence to current Pap test screening interval guidelines was associated with intention to change screening frequency (OR = 1.39 (1.01–1.91)). Conclusions: Many providers anticipate adjusting screening for vaccinated women, but a significant group believes nothing will change or are unsure. The present study provides important baseline data on intentions in the period preceding widespread vaccine diffusion and may help explain current and future trends in practice patterns.

Additional keywords: Pap cytology, prevention.


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