Reasons that clinicians in Australia offer cervical screening outside guidelines for frequency, age and co-testing

Objectives and importance of study: Changing cancer screening programs is notoriously difficult and may be influenced by clinicians' willingness to adhere to new guidelines. Our objective was to investigate clinicians' adherence to revised cervical screening guidelines and to identify any reasons for testing outside the revised guidelines.

Australian clinicians involved in cervical screening and treating women with cervical abnormalities were invited to complete a cross-sectional online survey between September 2019 and February 2020. We measured self-reported adherence to cervical screening guidelines for three common scenarios and analysed free-text reasons for offering tests contrary to guidelines using content analysis.

A total of 607 clinicians (283 general practitioners [GPs], and 324 obstetricians and gynaecologists [O&Gs]) were eligible and participated. Of these, 37.8% of GPs and 43.8% of O&Gs would provide testing more frequently than indicated by guidelines, but recognised the need for patients to be aware of the additional cost and for guidelines to be explained; 13.9% of GPs and 10.2% of O&Gs would screen women at a younger age than indicated due to patient request, patient/family history and the need for patient reassurance; and 11.4% of GPs and 23.6% of O&Gs would perform a HPV and cytology co-test when not indicated, mainly as a result of a mistake or lack of familiarity with guidelines, patient/family history and patient reassurance. Patient request for testing was a reason for testing outside the guidelines with regard to frequency of testing, age of testing and co-testing.

These data suggest that it is likely cervical screening outside guidelines is occurring in Australia. As patients often request these tests, strategies to reduce screening outside the guidelines should include ensuring that women are aware of the financial implications and the reasons for the updated guidelines.