title: Type-specific HPV and Pap test results among low-income, underserved women: providing insights into management strategies.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. Electronic address: msaraiya@cdc.gov.
authors.forename: Mona
authors.initials: M
authors.lastname: Saraiya
authors.affiliation: 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.
authors.forename: Vicki B
authors.initials: VB
authors.lastname: Benard
authors.affiliation: Battelle, Health & Analytics, Seattle, WA.
authors.forename: April A
authors.initials: AA
authors.lastname: Greek
authors.affiliation: 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.
authors.forename: Martin
authors.initials: M
authors.lastname: Steinau
authors.affiliation: 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.
authors.forename: Sonya
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: George F
authors.initials: GF
authors.lastname: Sawaya
authors.affiliation: 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.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Unger
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007087:Illinois; D008875:Middle Aged; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D011203:Poverty; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears; D035862:Vulnerable Populations; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology
keywords: HPV testing; Pap test; cotesting; genotying; underserved populations