When new guidelines for cervical cancer screenings were released in April of 2020 by a national consortium of 19 organizations convened by the American Society of Colposcopy and Cervical Pathology (ASCCP), they didn’t garner much attention, as most of the country was focused on the emerging pandemic.
“It was the worst timing. The new guidelines should have been big news,” says Rebecca Perkins, MD, MPH, obstetrics and gynecology physician at BMC, and co-chair of the 2019 ASCCP Risk-Based Management Consensus Guidelines Committee that developed the guidelines.
“They marked a paradigm shift from screening based on test-based algorithms to screening based on a patient’s individual risk. But many physicians and other healthcare providers were not aware of them.”
Perkins says the new ASCCP guidelines are evidence-based and logical, allowing doctors to concentrate on performing colposcopies and treatments on individuals who are very high risk for cervical cancer, while performing fewer colposcopies on individuals who are lower risk. But she notes the guidelines also add a layer of complexity to screening decisions.
“You aren’t just looking at one result anymore,” says Perkins. “You’re looking at the results from today and the results from last year and sometimes even further back into the past. That can make it confusing to know who needs screening and when, especially for patients with minimally abnormal results.”
Launch of the cervical cancer risk assessment tools for doctors and patients
To help navigate this complexity, the ASCCP developed an app for providers to streamline navigation of the guidelines and determine next steps for their patients. However, there was no such tool created for patients. So, Perkins decided to build one.
“I thought it would be good for patients to have their own tool, so they could have the same access to this information as their healthcare providers,” says Perkins. The new cervical cancer personalized risk assessment tool launched on BMC’s website in July 2021. A Spanish-language version is due to launch soon.
Individuals can plug in information about their own screening history and receive personalized information about their overall risk for cervical cancer as well as what steps to take next based on national guidelines. They can also read more about the importance of cervical cancer screenings, the human papillomavirus (HPV) vaccine, and the difference between HPV and Pap tests. A glossary defines all the medical terms, and the tool provides links to relevant websites for more information on cancer and cancer screenings.
Empowering patients through knowledge
Perkins hopes the tool will help empower patients who may not be getting regular screenings due to a lack of knowledge or provider recommendation. “Knowledge is power. Patients can use this tool to inform themselves about what screening they need.”
In fact, disseminating knowledge about screenings may be more important than ever, especially for women of color. The number of women who were not up to date with their cervical cancer screenings increased between 2005 and 2019, from 14% to 23%, according to a recent study on more than 20,000 U.S. women. Those most likely to be overdue include Hispanic and Asian women, women who identified as LGBTQ+, and women who lived in rural areas or who lacked insurance. The most common reason women give for not having a cervical cancer screening is lack of knowledge that they are due for one.
Screening recommendations have changed over the years as the medical community’s understanding of cervical cancer has evolved. “We now know that HPV is the cause of over 99% of cervical cancers, and the HPV test picks it up more than 90% of the time,” says Perkins. “This is why women who are considered average risk can be screened with HPV testing with or without a Pap test every five years.”
The most common reason women give for not having a cervical cancer screening is lack of knowledge that they are due for one.
However, she cautions that patients and providers alike need to know that some women, such as those with a history of HPV or abnormal test results, need to be screened more often. Perkins hopes this tool will help clarify these subtle, yet important, differences.
Perkins’ involvement on the President’s Cancer Panel
For the past two years, Perkins has been involved with the President’s Cancer Panel, which recently released its report on cancer screenings. Perkins served as co-chair of the subcommittee on cervical cancer.
In the report, the cancer panel lists four goals:
- Improve and align cancer screening information
- Facilitate equitable access to screening
- Strengthen workforce collaborations to support cancer screening and risk assessment
- Create health information technology that promotes appropriate cancer risk assessment and screening
Perkins hopes that by reaching these goals, they can begin to address some of the barriers to cervical cancer screening. She says these include a lack of knowledge about testing, patients not having access to healthcare or not being able to get to appointments, and a general backlog for preventive screenings since the start of the COVID-19 pandemic. On the clinician side, healthcare providers may not be aware of new guidelines or may not understand how to use risk to determine when a patient is due for screening.
Using technology to boost cancer screenings
The cervical cancer risk assessment tool Perkins developed fits particularly well under the fourth goal. She says it’s just one example of how hospitals can use technology to support clinical guidelines.
“Embedding clinical decision support tools in hospital websites, electronic medical records, and laboratory information systems can help providers know what to do when they get HPV results back,” she says.
“It’s also really crucial for screening. If a patient shows up to clinic, the electronic medical record can be set up so the provider is prompted that the patient is due for screening.”
Perkins says these reminders are especially important now that there may be up to five-year intervals between screenings. “We have this amazing science, and yet in many cases our systems haven’t caught up to correctly implementing these longer intervals.”
In addition to technology, Perkins sees the need for good patient-doctor relationships, especially for patients who are in traditionally underserved groups that might have less trust in the healthcare system.
“I think there’s a need to connect patients to healthcare providers with whom they feel safe and cared for and where there’s a lot of trust. And then within that relationship, there needs to be some kind of electronic reminder system that alerts both patients and healthcare providers when cancer screenings are due, so people can respond and act.”
