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Background: Current cervical cancer screening guidelines include the option of lengthening the screening interval to 5 years for average-risk women aged 30-65 years when screened with Pap and human papillomavirus (HPV) test (co-test). Because many providers are reluctant to extend screening intervals, we launched an educational intervention to promote recommended screening practices. The study objective was to assess changes in provider attitudes and beliefs to extending screening intervals among low-income women. Methods: The study was conducted in 15 clinics in Federally Qualified Health Centers in Illinois. Providers in the intervention arm received a multicomponent educational intervention. Fifty-six providers ( n = 29 intervention and n = 27 control) completed baseline and 12-month follow-up surveys assessing beliefs and intentions about extending screening intervals. Results: The 12-month assessment showed providers in the intervention arm were significantly more likely than those in the control arm to recommend a 3-year screening interval (guideline recommendation at time of study) with a normal co-test result. Providers who received the intervention were significantly more likely to agree that routine co-testing is the best way to screen for cervical cancer, that extending the screening interval would be good, easy, and beneficial, and to disagree that the increased screening interval would cause patients to lose contact with the medical system. Conclusion: Educating providers on the natural history of HPV infection and cervical cancer and the benefits of extended intervals increased their willingness to follow guidelines. This study provides evidence that an educational intervention delivered with HPV testing materials may be effective in encouraging appropriate cervical screening intervals. [ABSTRACT FROM AUTHOR]

Background: The recommended screening interval when using the Papanicolaou (Pap) and human papillomavirus (HPV) test (co-testing) is 5 years. However because providers are reluctant to extend the screening interval, we launched a study to identify barriers to appropriate use of the co-test and to implement an educational intervention to promote evidence-based screening practices. This article provides an overview of the study including the multi-component intervention and participant demographics. Methods: The study was conducted in 15 clinics associated with 6 Federally Qualified Health Centers (FQHCs) in Illinois. Each clinic received HPV tests to administer with routine Pap tests among enrolled patients ( n=2,246) and was assigned to a study arm: intervention arm ( n=7) received a multi-component educational intervention (small media, academic detailing, and website) for providers and printed educational materials for patients, and control arm ( n=8) received printed copies of general guidelines. Clinic coordinators ( n=15), providers ( n=98), and patients ( n=984) completed baseline surveys to assess screening practices. Results: Providers reported an average age of 41.3 years and were predominately female, non-Hispanic, and white. Patients reported an average age of 45.0 years and nearly two-thirds were Hispanic or black. Of the 2,246 patients, 89% had a normal co-test. Lessons learned from the study included the importance of buy-in at a high level in the organization, a champion provider, and a clinical coordinator devoted to the study. Conclusion: Materials from this study can be adapted to educate providers and patients on appropriate use of the co-test and encourage extended screening intervals as a safe and effective practice. [ABSTRACT FROM AUTHOR]

Background: Approximately 6% of breast cancers in the United States occur in women under the age of 40 years. Compared with women ≥40 years of age, younger women are diagnosed at later stages, have higher rates of recurrence and death, and may be predisposed to secondary breast or ovarian cancer. An informal meeting of experts discussed opportunities for research and public health communication related to breast cancer among young (<40 and/or premenopausal) women. Methods: In September 2011, the Centers for Disease Control and Prevention hosted 18 experts in oncology, genetics, behavioral science, survivorship and advocacy, public health, communication, ethics, nutrition, physical activity, and environmental health. They (1) reviewed research and programmatic knowledge on risk and preventive factors, early detection, and survivorship; and (2) discussed ideas for research, communication, and programmatic efforts related to young women diagnosed with or at risk for early onset breast cancer. Results: Levels of evidence and themes for future research regarding risk and preventive factors, including exposures, were discussed. Early detection strategies, including screening, risk assessment, and genetic counseling, as well as survivorship issues, follow-up care, fertility and reproductive health, and psychosocial care were highlighted. Conclusion: Community and academic researchers, providers, advocates, and the federal public health community discussed strategies and opportunities for this unique population. Although the evidence is limited, future research and communication activities may be useful to organize future public health initiatives. [ABSTRACT FROM AUTHOR]

Background: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides low-income, uninsured women with screening and diagnostic services for breast and cervical cancer. Our study was conducted to describe the demographic and practice characteristics of participating and nonparticipating physicians, as well as their beliefs, adoption of new screening technologies, and recommendations for breast and cervical cancer screening. Methods: From a 2006-2007 nationally representative survey, we identified 1,111 practicing primary care physicians who provide breast and cervical cancer screenings and assessed their recommendations using clinical vignettes related to screening initiation, frequency, and cessation. Responses of physicians participating in the NBCCEDP were compared with those from nonparticipating physicians. Results: Of the physicians surveyed, 15% reported participation in the NBCCEDP, 65% were not participants, and 20% were not sure or did not respond to this question. Program physicians were significantly more likely to practice in multispecialty settings, in a rural location, and in a hospital or clinic setting and had more patients who were female and insured by Medicaid or uninsured compared with nonprogram physicians. Beliefs about the effectiveness of screening tools or procedures in reducing breast or cervical cancer mortality were similar by program participation. Adoption of new technologies, including digital mammography and human papillomavirus (HPV) testing, and making guideline-consistent recommendations for screening initiation, frequency, and cessation did not differ significantly by program participation. Conclusions: Although there may be differences in physician characteristics and practice settings, the beliefs and screening practices for both breast and cervical cancer are similar between program and nonprogram providers. [ABSTRACT FROM AUTHOR]

Background: Since 2003, newer cervical cancer screening guidelines that include human papillomavirus (HPV) testing with cytology (HPV co-testing) call for extension of screening intervals in women who are cytology normal and HPV negative. Continuing medical education (CME) may help increase knowledge and appropriate adoption of new technologies and guidelines. However, there are concerns that industry support of CME may bias messages favoring newer technologies without emphasizing the updated guidelines, especially less frequent testing recommendations. Our objectives were to assess availability and accuracy of web-based CME activities describing cervical cancer screening guidelines, screening intervals, and HPV testing. Methods: We identified 20 web-based CME activities available between 2006 and 2008 and evaluated the content for messages related to HPV and natural history, cervical cancer screening guidelines, management of HPV abnormalities, and counseling tips for patients. In addition to content, we noted funding source, credit offered, and dates available. Results: Most activities (80%) discussed the updated screening guidelines with HPV co-testing for eligible women. Twelve activities (60%) referenced professional organization support of the extended screening interval with the HPV co-test, and three (15%) discussed the justification for extension of intervals for eligible women. Eight activities (40%) were funded by industry, seven of which included accurate, updated screening guidelines about extension of screening intervals. Conclusions: Web-based CME activities generally support updated guidance for HPV co-testing and extended screening intervals but need more information on counseling patients and acceptability of extending screening intervals. [ABSTRACT FROM AUTHOR]

Background: Adjunct human papillomavirus (HPV) testing with cervical cytology (Pap test) is one option that can increase screening intervals for women aged ≥30 years who have concurrent negative (normal) test results. Previous research suggests that most women are unaware of the relationship between HPV and cervical cancer. In addition, patients often do not understand the significance of their HPV test results, let alone the implications of negative results for future cervical cancer risk or screening options. Patient education materials that explain new screening methods and guidelines for cervical cancer screening with HPV testing can improve resource utilization and support patients making screening decisions. Methods: We identified cervical cancer screening materials published from 2004 through 2006 by U.S. government and nonprofit agencies, pharmaceutical companies, and professional associations via a web-based search. We reviewed those materials for content relating to HPV and HPV testing, screening guidelines, and reading grade level. Results: Eleven patient education materials met selection criteria for this review. Seven materials (five of which were industry sponsored or produced) promoted updated guidelines for women with concurrent negative HPV and cytology test results. The mean reading grade level of materials was found to be approximately ninth grade. Conclusions: This review highlights the need for more comprehensive, plainer language patient education materials that explain new technologies in cervical cancer screening. [ABSTRACT FROM AUTHOR]