HPV testing up, but communication gap remains

Physicians are increasingly incorporating testing for this virus into cervical cancer screening protocols but don't necessarily know how to talk about the results.

By Victoria Stagg Elliott, AMNews staff. Oct. 11, 2004.

When Dwight Im, MD, tells women they have tested positive for the human papillomavirus, some get very angry. They blame their partners and question their fidelity. Sometimes, they report feeling ashamed. Other times, they become fearful because of the increased risk of cervical cancer associated with the virus. He tries to alleviate their anxieties, but, like many physicians who are testing more patients for HPV, he's not quite sure what to say.

"It's hard," said Dr. Im, co-director of the gynecologic oncology center at Mercy Medical Center in Baltimore.

HPV testing has become more commonplace, but women's health experts are beginning to recognize that the increase in the test's frequency has outpaced many physicians' ability to communicate what it means.

"When you tell a patient she has an abnormal Pap smear, that's one thing," said Dr. Im. "If you tell her she has an STD, that's a whole other issue."

The September/October CA: A Cancer Journal for Clinicians featured a review article and accompanying editorial exploring these communication challenges. The authors highlighted the need for better patient education, preferably before a physician orders the test, and the development of shared decision-making tools to address patients' lack of knowledge.

"The gap is substantial," said Diane Harper, MD, MPH, an associate professor of obstetrics-gynecology and community and family medicine at Dartmouth Medical School in Hanover, N.H., who authored the accompanying editorial. "For people to have absolutely no idea of what it is or where it comes from is something that we have to work on as a physician community."