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. 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.

Racial and ethnic differences in human papillomavirus positivity and risk factors among low-income women in Federally Qualified Health Centers in the United States

“…HPV tests were provided by the study as part of their cervical cancer screening, and were sent to CDC for processing. HPV positivity was defined as the detection of 37 HPV types (6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 45, 51, XR(52), 53, 54, 55, 56, 58, 59, 61, 62, 64, 66, 67, 68, 69, 70, 71, 72,73, 81, 82, 83, 84, 89, and IS39), assessed by Linear Array HPV genotyping assay (Roche Diagnostics, Indianapolis, IN) (Saraiya et al, 2014). Participants were offered a $5 cash incentive for completing the survey.…”

Cervical Pathology in High-Risk Human Papillomavirus-Positive, Cytologically Normal Women

“…The most common pattern of positive cotests is a HR-HPV-positive/cytology-negative results which ranges from approximately 4% to 9% (Castle et al, 2009;Wiley et al, 2012;Tabrizi et al, 2014;Carozzi et al, 2014;Saraiya et al, 2014). As compared to the results from areas with a low incidence of cervical cancer, Thai women with abnormal cervical cytology carry a higher risk of encountering significant cervical lesion (Kietpeerakool Buasorn Supho, Amornrat Supoken, Pilaiwan Kleebkaew, Chumnan Kietpeerakool* et al, 2009;Poomtavorn et al, 2011;Aue-Aungkul et al, 2011;Ingkapairoj et al, 2012).…”

Understanding the Dynamics of Human Papillomavirus and Diagnostic Discrepancies in Cervical Pathology: A Single Center Experience

“…The aforementioned statement holds true for HPV types 58, 31, and 33 as well (Figure 1). These types have been found to exhibit higher prevalence rates among females residing in developing countries, in contrast to those in high-income regions [29]. The significance of this matter lies in the fact that these particular types serve as indicators for an increased likelihood of experiencing higher rates of morbidity in relation to cervical CIN II and CIN III lesions [30].…”