In Pap We (Still) Trust

By Kait Scalisi, MPH

A recent national survey shows distrust of new cervical cancer screening recommendations as well as a lack of knowledge and understanding among women about HPV, cervical cancer, and more.

Cervical Cancer Today: A National Survey of Attitudes and Behaviors, a collaboration between the National Association of Nurse Practitioners in Women’s Health (NPWH) and HealthyWomen (HW) surveyed over 2,000 women and nearly 1,000 healthcare providers to gain a better understanding of women and HCPS’s attitudes and decisions in the exam room. The major finding: we’re all resistant to change.

For example, the Pap test, long viewed as the gold standard of cervical cancer detection, although recently replaced/addenedumed by the HPV test, is highly trusted by both healthcare providers and women/patients. The newer HPV test, only recently approved as a first-line screening/primary screening tool, however, is not a preferred method.

Other major themes included:

Both women and healthcare providers like routine and time-tested screening. More likely this finding represents fear of the unknown rather than a love for the Pap test itself.
Women lack basic knowledge about their sexual and reproductive health, including how HPV actually works.
Race matters.

It is well established that many racial minorities have a distrust of the health care system due to systematic oppression and being taken advantage of (Henrietta Lacks may be the most well-known example, but certainly isn’t the exception or the only one). When it comes to their cancer screenings, African American and Hispanic women were even more concerned with cutting back on the number of tests or lengthening the time between tests, regardless of the type of test.

The survey also speaks to larger issues: policy changes being made without appropriate health promotion campaigns. Women reported being distrustful of lengthening the time between tests, a sentiment that the healthcare providers reported expecting. Public health professionals know that switching from annual Paps to once every three years is cost-effective and does not have much of an impact on incidence. However, when this is not communicated to the public clearly in places where they can ask questions or get more information (e.g. social media, doctor’s offices), it leads to the distrust reported in this survey. The question then is, how can medicine and public health work together to craft policies that are known to be effective, and then share them with the public in an accessible way?

Secondly, the survey’s results speak to the need for more factual and comprehensive sex education at all ages. A considerable percentage of the women surveyed did not know that HPV causes cancer, or that there are treatments for it. A representative from one of the sponsoring organizations notes:

“Healthcare providers need to help women understand the significance – or lack thereof – of an HPV infection[…]Women need comprehensive information about the meaning of both HPV and Pap tests when deciding how to protect themselves from cervical cancer.”

While this sentiment is true, it is also on public health professionals to push for programs and campaigns that meet women where they are, and help get them this information. This includes getting them the information as early as possible.

The issues with our health care system run deep—high burdens on providers, short appointment times, competing interests, etc.—and aren’t likely to change soon. Plus healthcare providers express hesitation in talking about sex and sex-related topics like STIs, HPV, and cervical cancer. The only solution is for public health and medicine to work together to further each other’s interests so that patients have reliable sources of health infomration from sources other than their providers, who simply cannot cover everything in one visit.