Type-specific HPV and Pap test results among low-income, underserved women: providing insights into management strategies - 26/06/14

Doi : 10.1016/j.ajog.2014.05.001

Mona Saraiya, MD, MPH ^a,^⁎ , Vicki B. Benard, PhD ^a, April A. Greek, PhD ^c, Martin Steinau, PhD ^b, Sonya Patel, BS ^b, L. Stewart Massad, MD ^d, George F. Sawaya, MD ^e, Elizabeth R. Unger, MD, PhD ^b
^a Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
^b Division of High-Consequence Pathogens and Pathology, Chronic Viral Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
^c Battelle, Health & Analytics, Seattle, WA
^d Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO
^e Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA

^∗Reprints: Mona Saraiya, MD, MPH, 4770 Buford Hwy, NE, MS K-55 Atlanta, GA 30341.

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Abstract

Objective

The primary cervical cancer screening strategy for women over age 30 is high-risk human papillomavirus (HPV) testing combined with Papanicolaou (Pap) testing (cotesting) every 5 years. This combination strategy is a preventive service that is required by the Affordable Care Act to be covered with no cost-sharing by most health insurance plans. The cotesting recommendation was made based entirely on prospective data from an insured population that may have a lower proportion of women with HPV positive and Pap negative results (ie, discordant results). The discordant group represents a very difficult group to manage. If the frequency of discordant results among underserved women is higher, health care providers may perceive the cotesting strategy to be a less favorable screening strategy than traditional Pap testing every 3 years.

Study Design

The Centers for Disease Control and Prevention's Cervical Cancer Study was conducted at 15 clinics in 6 federally qualified health centers across Illinois. Providers at these clinics were given the option of cotesting for routine cervical cancer screening. Type-specific HPV detection was performed on residual extracts using linear array.

Results

Pap test results were abnormal in 6.0% and HPV was positive in 7.2% of the underserved women screened in this study (mean age, 45.1 years). HPV prevalence decreased with age, from 10.3% among 30- to 39-year-olds to 4.5% among 50- to 60-year-olds. About 5% of the women had a combination of a positive HPV test and normal Pap test results; HPV 16/18 was identified in 14% of discordant women.

Conclusion

The rate of discordant results among underserved women was similar to those reported throughout the US in a variety of populations. Typing for HPV 16/18 appears to assist in the management in a small proportion of women with discordant results.

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Key words : cotesting, genotying, HPV testing, Pap test, underserved populations

Plan

Materials and Methods

	This manuscript was written in the course of employment by the United States Government with support from services provided by a contract with Battelle (200-2002-00573, Task Order no. 0006) and is not subject to copyright in the United States. Qiagen and Roche Molecular Diagnostics provided in-kind support for testing reagents through the CDC Foundation. Diane Manninen, PhD was the project manager from Battelle.
	The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).
	The authors report no conflict of interest.
	Cite this article as: Saraiya M, Benard VB, Greek AA, et al. Type-specific HPV and Pap test results among low income, underserved women: providing insights into management strategies. Am J Obstet Gynecol 2014;211:x-ex-x-ex.