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. 2015 Jun 15;136(12):2854-63.
doi: 10.1002/ijc.29337. Epub 2014 Dec 1.

Human papillomavirus testing 2007-2012: co-testing and triage utilization and impact on subsequent clinical management

Jack Cuzick  1 , Orrin Myers, William C Hunt, Debbie Saslow, Philip E Castle, Walter Kinney, Alan Waxman, Michael Robertson, Cosette M Wheeler; New Mexico HPV Pap Registry Steering Committee
Collaborators, Affiliations

Human papillomavirus testing 2007-2012: co-testing and triage utilization and impact on subsequent clinical management

Jack Cuzick et al. Int J Cancer. .

Abstract

In the United States, high-risk human papillomavirus (HPV) testing is recommended for women with atypical squamous cells of unknown significance (ASC-US) cytology, and co-testing with cytology and HPV is a recommended option for screening women aged ≥ 30 years. No population-based data are available to examine utilization of HPV testing in the United States. Using the New Mexico HPV Pap Registry data resource, we describe population trends (2007-2012) in utilization and positivity rates for HPV testing as a routine co-testing screening procedure and for triage of ASC-US and other cytologic outcomes. For women aged 30-65 years co-testing increased from 5.2% in 2007 to 19.1% in 2012 (p < 0.001). Overall 82% of women with ASC-US cytology who did not receive co-testing also had an HPV test. HPV positivity was age and cytology result dependent but did not show time trends. For women with negative cytology, 64% received an additional screening test within 3 years if no co-test was done or if it was positive, but this was reduced to 47% with a negative co-test. Reflex HPV testing for ASC-US cytology is well established and occurs in most women. Evidence for reflex testing is also observed following other abnormal cytology outcomes. Co-testing in women aged 30-65 years has more than tripled from 2007 to 2012, but was still only used in 19.1% of women aged 30-65 years attending for screening in 2012. Women receiving co-testing had longer repeat screening intervals, but rescreening within 3 years is still very common even with co-testing.

Keywords: HPV co-testing; New Mexico; New Mexico HPV Pap Registry; United States; cervical screening; coverage; high-risk HPV testing; outcome; utilization.

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Conflict of interest statement

Potential Conflicts of Interest: Dr Cuzick has received research funding and reagents from Qiagen, Roche, GenProbe/Hologic, Abbott, BD, Cepheid, Genera and Trovagene, and has been personally compensated for Advisory Boards or Speakers Bureau activities by GenProbe/Hologic, Abbott, BD, Merck and Cepheid. Dr. Castle has received commercial HPV tests for research at a reduced or no cost from Roche, Qiagen, Norchip, mtm, BD and Arbor Vita Corp., has been compensated financially as a member of a merck Data and Safety Monitoring Board for HPV vaccines, paid as a consultant for BD, Gen-Probe/Hologic, Roche, Cepheid, ClearPath, Guided Therapeutics, Teva Pharmaceuticals, Inovio Pharmaceuticals, Genticel and GE Healthcare and has received honroraria as a speaker for Roche and Cepheid. Dr. Wheeler has received support for equipment and reagents for HPV genotyping from Roche Molecular Systems and contracts from Merck and GSK for HPV vaccine trials through her institution, the University of New Mexico. No other author has reported a conflict of interest.

Figures

Figure 1
Figure 1
Trends in HPV utilization by cytology result and age group. For negative cytology this consists of all results and is an estimate of the amount of co-testing. For abnormal cytology, number of HPV tests performed (numerator) and number not receiving co-testing (denominator) are computed by subtracting number of estimated co-tests based on results for negative cytology and is an estimate of the amount of HPV triage in those not receiving co-testing.
Figure 2
Figure 2
Trends in HPV positivity by screening cytology test result, age and year.
Figure 3
Figure 3
HPV positivity rate (%) and 95% confidence interval by screening cytology outcome and age. 2007 – 2012.
Figure 4
Figure 4
Time to follow up cytology (A), HPV test (B), biopsy (C) or any follow up (D) after normal screening cytology result by HPV co-test status for New Mexico women age 30 – 65 years. Time to second follow up (red-hued lines) is also shown for cytology, HPV tests and biopsies. Sample size and percent of sample by co-test status shown in panel A. Note that different panels have different vertical scales.
See this image and copyright information in PMC

References

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