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. 2021 Sep;162(3):555-559.
doi: 10.1016/j.ygyno.2021.06.029. Epub 2021 Jul 10.

Uptake of co-testing with HPV and cytology for cervical screening: A population-based evaluation in the United States

Jack Cuzick  1 , Ruofei Du  2 , Rachael Adcock  1 , Walter Kinney  3 , Nancy Joste  4 , Ruth M McDonald  5 , Kevin English  6 , Salina M Torres  7 , Debbie Saslow  8 , Cosette M Wheeler  9 ; New Mexico HPV Pap Registry Steering Committee
Collaborators, Affiliations

Uptake of co-testing with HPV and cytology for cervical screening: A population-based evaluation in the United States

Jack Cuzick et al. Gynecol Oncol. 2021 Sep.

Abstract

Objectives: Human papillomavirus (HPV) testing for cervical screening has been shown to increase the yield of precancerous disease and reduce the incidence of cervical cancer more than cytology alone. Here we document the state-wide uptake of co-testing with HPV and cytology in women aged 30-64 years as recommended by national and international bodies.

Methods: Registry-based study of all screening cytology and HPV tests in New Mexico from 2008 to 2019 among women aged 21-64 years, with a focus on cytology negative tests to distinguish co-testing from reflex HPV testing to triage equivocal or mildly abnormal cytology.

Results: A total of 1,704,055 cervical screening tests from 681,440 women aged 21-64 years in the state of New Mexico were identified. The proportion of screening tests which were co-tests rose from 5.6% in 2008 to 84.3% in 2019 among women aged 30-64 years with a marked change from the near exclusive use of the Hybrid Capture II HPV test, (a signal amplified test method) to the use of target amplified HPV tests. The largest increases were seen between 2013 and 2015, reflecting the introduction and adoption of new clinical guidelines. Increases in co-testing were also seen in younger women.

Conclusions: Co-testing is now well established in women aged 30-64 years, but smaller increases have also been seen at younger ages, although this is not currently recommended. The impact of co-testing on cervical disease outcomes and number of colposcopies and biopsies in routine population settings remain important, especially in young women.

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Conflict of interest statement

Declaration of competing interest JC and CMW have received funds from grants, cooperative agreements or subcontracts related to cervical screening and triage through their respective institutions. JC reports personal fees from Hologic and grants from Becton Dickinson (BD), Qiagen and Gene First all outside the submitted work. CMW reports receiving reagents and equipment from Roche Molecular Systems, Roche/Ventana Medical Systems, Hologic and Genera Biosystems, research funding from Hologic all through her institution and outside of the submitted work, personal fees from BD. All other authors report no potential conflicts of interest.

Figures

Figure 1:
Figure 1:
Number of women with negative screening cytology with or without HPV co-tests, aged 30–64 years, by year. See Methods for the definition of a screening cytology. All screening cytology including positive results also shown. The change in number of women with negative screening cytology, by year (2008–2019), is plotted for women screening with negative cytology regardless of testing method, for women with negative cytology alone, and women co-tested with negative cytology. Screening cytology is restricted to the first per women in each calendar year. For comparison number of negative screening cytology in all women screening is also plot as is all screening cytology including positive results. . Numbers screening are restricted to women aged 30–64 years.
Figure 2:
Figure 2:
Proportion of women with negative screening cytology co-tested (HPV and cytology), by year and age group. The proportion of women who were co-tested out of all women with negative screening cytology is plotted, by year (2008–2019). Curves are plotted separately for women aged 21–24 years, 25–29 years and 30–64 years.
Figure 3:
Figure 3:
Number of HPV tests within −5 and +28 days of cytology (co-test or reflex HPV) by assay in New Mexico, 2008 – 2019 Total number of HPV tests performed within −5 and +28 days of cytology (co-test or reflex HPV test) by assay type are plot by year (2008–2019). HPV assay types include the most used in New Mexico (Aptima, Cervista, Cobas, HC2 and Seegene).
See this image and copyright information in PMC

References

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