General practitioners’ perception of risk factors for cervical cancer development: Consequences for patient education

https://doi.org/10.1016/j.pec.2005.08.004Get rights and content

Abstract

Objective

The introduction of human papillomavirus (HPV) detection in cervical screening will make it necessary to provide appropriate information to the general public. Only 3% of Flemish women could name HPV as the viral agent involved in cervical cancer development. The aim of this study was to investigate whether general practitioners (GPs) have appropriate knowledge of the relationship between HPV and cervical cancer to be able to inform women.

Methods

A questionnaire was developed to measure perception of 20 risk factors for cervical cancer development, on a scale of 1 (unimportant) to 5 (very important). Respondents were also asked to give an estimate of the chances of survival for women, diagnosed with cervical cancer detected by screening.

Results

Sixty GPs and 28 trainees filled in the questionnaire. The five most important risk factors in the perception of the respondents were, in order of decreasing importance, viral infection, number of sex partners, sexual behaviour of the partner, unsafe sex, and early start of sexual activity. Fifty-six percent of the GPs expected the chance of survival to be between 80 and 100%, compared to only 31% of the trainees.

Conclusion

Most GPs are well aware of sexual habits as risk factors for cervical cancer development, including the role of HPV as the viral agent in the etiology. However, they seem to underestimate the role of smoking and are unable to identify the correct chance of survival for women in whom cervical cancer is detected within the frame of the cervical smear program.

Practice implications

Attention should be given to education of medical students and practitioners, in order to allow them to supply patients with sufficient background information to make an informed choice on participating in cervical cancer screening.

Introduction

Accumulated evidence for the pivotal role that human papillomavirus (HPV) plays in the development of cervical cancer, has fuelled the search for applications of HPV in vaccine development and primary and secondary cervical screening. Already, HPV detection is used in triage of borderline or mildly dyskaryotic smear results [1], [2]. Last year, the United States Food and Drug Administration has approved Digene's Hybrid Capture 2 assay for use with a Pap test to adjunctively screen women aged 30 years and older for the presence of high-risk HPV infection. This was based on the theory that after the age of 30, the negative predictive value of both Pap and HC2 assays would improve the sensitivity of cervical cancer screening. This introduction of HPV detection in cervical screening will make it necessary to provide appropriate information to the general public. Several studies have been performed to investigate the knowledge of HPV, but mostly in college students [3], [4], [5], [6]. From these studies, it can be concluded that knowledge of HPV is very limited. In a previous study, we have developed a questionnaire concerning risk factors for cervical cancer development which was completed by 162 women [7]. From this study, it appeared that the women were not well informed of the most important risk factors, and almost unaware of the role of HPV as a sexually transmitted agent. Only 3% of the women could name HPV as the viral agent involved in cervical cancer development. Furthermore, it would appear that the majority of the women did not obtain the information needed to fill in the questionnaire from their general practitioner or gynaecologist. The aim of this study was to investigate whether general practitioners have appropriate knowledge of the relationship between HPV and cervical cancer to be able to inform women presenting for cervical screening.

Section snippets

Methods

A three-page self-administered questionnaire was developed to measure perception of risk factors for cervical cancer development. The questionnaire contained 20 possible risk factors. Respondents were asked to rate their view of the impact of a given risk factor on the development of cervical cancer on a scale of 1 (unimportant) to 5 (very important). In the case of two risk factors (bacterial and viral infection), there was room for naming the agent involved, if known. The final question asked

Results

Sixty GPs filled in the questionnaire (33 men, 24 women, 3 did not specify gender). Twenty-eight trainees also filled in the questionnaire (10 men, 18 women). The 20 risk factors suggested in the questionnaire were: smoking, alcohol, drugs, young age at start of sexual activity, number of sex partners, sexual behaviour of the male partner, bacterial infection, viral infection, large number of children/pregnancies, immune suppression (e.g. due to transplantation), hormonal therapy (e.g. due to

Discussion

Currently, in Flanders, Belgium, HPV DNA testing is only being used for triage of ASCUS smears. However, in the light of the approval by the FDA of the Hybrid Capture 2 test for simultaneous Pap smear and HPV testing, it can not be ruled out that HPV testing will become a routine test in women of 30 years and older. In both situations, accurate information about HPV will be crucial to inform women's screening choices and to avoid psychosocial problems in women with positive HPV DNA test

Competing interests

The authors declare that they have no competing interests.

Acknowledgements

This study was financed in part by a Research Grant of the Fund for Scientific Research-Flanders (Belgium) to JBV. We are grateful to all general practitioners who participated in this study.

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