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Human papillomavirus vaccine practices in the USA: do primary care providers use sexual history and cervical cancer screening results to make HPV vaccine recommendations?
  1. Deanna Kepka1,
  2. Zahava Berkowitz2,
  3. K Robin Yabroff1,
  4. Katherine Roland2,
  5. Mona Saraiya2
  1. 1Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
  2. 2Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Dr Deanna Kepka, Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, Room 4017, 6130 Executive Boulevard, MSC 7344, Bethesda, MD 20892-7344, USA; deanna.kepka{at}


Objectives Guidelines recommend against the use of Papanicolaou (Pap) or human papillomavirus (HPV) testing when determining eligibility for the HPV vaccine. Optimally, the HPV vaccine should be administered before sexual initiation. Guidelines recommend that age-eligible women with past exposure to HPV should still be vaccinated. Little is known about how primary care providers (PCPs) use sexual history and HPV and Pap tests in their HPV vaccine recommendations.

Methods Data from the 2007 Cervical Cancer Screening Supplement (CCSS) administered with the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to assess HPV vaccination recommendations. The CCSS investigates cervical cancer screening practices, HPV testing and HPV vaccine recommendations among PCPs. A summary measure of compliance with guidelines was defined as rarely or never using the number of sexual partners and HPV tests and Pap tests to determine vaccine receipt. A total of 421 PCPs completed the CCSS in 2007.

Results Among NAMCS and NHAMCS providers who recommend the HPV vaccine, only 53% (95% CI 42% to 63%) reported making guideline-consistent recommendations. The majority reported sometimes to always recommending the HPV vaccine to women with a history of an abnormal Pap result (85%; 95% CI 75% to 91%) and a positive HPV test (79%; 95% CI 70% to 86%).

Conclusions A large proportion of providers report practices that are inconsistent with guidelines. Providers may also be recommending the vaccine to women who may receive little benefit from the vaccine. Provider and system-level efforts to improve guideline-consistent practices are needed.

  • Cervical cancer
  • cervical neoplasia
  • HPV
  • HPV test
  • Papanicolaou test
  • practice guidelines, prevention
  • primary care
  • primary care providers
  • public health
  • sexual history

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  • The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Cancer Institute or the Centers for Disease Control and Prevention.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.