title: Human papillomavirus testing 2007-2012: co-testing and triage utilization and impact on subsequent clinical management.
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.
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.forename: Orrin
authors.initials: O
authors.lastname: Myers
authors.forename: William C
authors.initials: WC
authors.lastname: Hunt
authors.forename: Debbie
authors.initials: D
authors.lastname: Saslow
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.forename: Walter
authors.initials: W
authors.lastname: Kinney
authors.forename: Alan
authors.initials: A
authors.lastname: Waxman
authors.forename: Michael
authors.initials: M
authors.lastname: Robertson
authors.forename: Cosette M
authors.initials: CM
authors.lastname: Wheeler
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D009516:New Mexico; D027383:Papillomaviridae / Q000302:isolation & purification* / Q000502:physiology; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data / Q000639:trends; D012042:Registries / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology
keywords: HPV co-testing; New Mexico; New Mexico HPV Pap Registry; United States; cervical screening; coverage; high-risk HPV testing; outcome; utilization