title: Trends of human papillomavirus testing in cervical cancer screening at a large academic cytology laboratory.
abstract: OBJECTIVE
  To estimate time trends of actual provider use of human papillomavirus (HPV) testing in cervical cancer screening by using laboratory and administrative data from the Johns Hopkins Hospital Division of Cytopathology in Baltimore, Maryland.
  
  
  METHODS
  In this ecologic trend study, we analyzed 178,510 Pap specimen records and 12,221 HPV tests among 85,048 patients from 2001 to 2007. Monthly frequencies and proportions of HPV reflex testing and HPV cotesting with Pap (stratified by patient ages 30 and older and 18-29 years) were calculated. Time trends of monthly HPV testing proportions were analyzed using joinpoint regression methods.
  
  
  RESULTS
  From April 2002, when the American Society for Colposcopy and Cervical Pathology added HPV reflex testing to its guidelines, to December 2007, the monthly the proportion of reflex testing was 95.8%. From February 2004, when the society added HPV cotesting with Pap among women aged 30 years or older to its guidelines, to December 2007, the overall proportion HPV cotesting with Pap among patients aged 30 years or older was 7.8% (compared with 4.9% among patients 18-29 years [P<.01]). The highest proportion of HPV cotesting among women aged 30 years or older, 15%, was observed in September 2006, and the trend later plateaued around 13%. The monthly proportions of HPV reflex testing and cotesting with Pap changed significantly over time.
  
  
  CONCLUSIONS
  These data reveal that a small percentage of women aged 30 years or older received HPV cotesting with Pap, thus identifying a significant opportunity for providers to improve patient care in cervical cancer prevention.
  
  
  METHODS
  III.
authors.affiliation: From the Departments of Epidemiology and Health Policy and Management, Bloomberg School of Public Health, and the Department of Pathology, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Darcy F
authors.initials: DF
authors.lastname: Phelan
authors.forename: John K
authors.initials: JK
authors.lastname: Boitnott
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Clark
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Dubay
authors.forename: Patti E
authors.initials: PE
authors.lastname: Gravitt
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears / Q000706:statistics & numerical data; D055815:Young Adult