[1071] HPV DNA Testing: Is It Used Appropriately?

S Davion, E Lucas, A Kemp, R Nayar. Northwestern University, Chicago, IL

Background: Triage of ASC-US by HPV DNA testing was endorsed by the ASCCP in 2001. In 2003 the FDA approved Pap plus HPV co-testing for primary screening of women ≥30 yrs. The high prevalence of HPV in women ≤ 20 (adolescents) lead to recommendations against any HPV testing in this age group. The 2006 ASCCP guidelines, and the “Statement on Human Papillomavirus DNA Test Utilization”, a consensus of the NCI, ASCCP and ACS, endorsed the above recommendations. Since the 2006 ASCCP consensus, a few survey-based studies have evaluated compliance. We have anayzed the use of Pap and HPV DNA results, to screen, triage and manage, by reviewing actual HPV/Pap ordering and follow up behaviors at a large academic institution at 11 and 20 months after the 2006 ASCCP consensus publication.
Design: All Paps ordered in Sept 2008 and June 2009 were included (N = 6,365). HPV testing strategy, ordering clinician specialty, and follow up for September 2008 Paps were recorded.
Results:

HPV DNA TESTING; SCREENING,TRIAGE AND MANAGEMENT BY SPECIALTY
SCREENINGSEPTEMBER '08 ( TOTAL / OBGYN / IM)JUNE '09 (TOTAL/ OBGYN / IM)
PRIMARY PAP + HPV ≥ 3018% / 23% /11%19% /25% /10%
PRIMARY PAP + HPV < 303% / 3% / 3%2% / 3% /1%
PAPS > 65 w/ CERVIX + NO ABNL PAP FOR 10 YRS.40% / 28 % / 54%37% / 34%/ 42%
REFLEX TESTING
PAP + REFLEX HPV >2079% / 73% / 88%82% / 76% / 90%
PAP + REFLEX HPV ≤ 2084% / 100% / 86%84% /88% / 86%
MANAGEMENT
NILM/HPV (-) W/ F/U PAP OR CX BX < 3 YEARS9%/ 9%/ < 1%
NILM/ HPV (+) W/ REPEAT PAP OR CX BX < 3 YRS.45 % / 52% / 0%
LSIL < 20 W/ CX BX < 1 YR.75% / 100 % 25%
HSIL >20 WITHOUT/ F/U LEEP OR CX BX AT 1 YR.33% / 32% / 33%
IM: INTERNAL MEDICINE, CX BX:CERVICAL BIOPSY


Conclusions: 1. Women ≥ 30 are not routinely screened with Pap+HPV co-testing (18%). 2. OBGYN are more likely than IM to screen women ≥ 30 with Pap+HPV co-testing (23% vs 11%). 3. NILM/HPV(-) results appear to prolong the screening interval to > 1 year. 4. NILM/HPV(+) women often proceed unnecessarily to repeat Pap or cervical biopsy in < 1 year (45%). 5. NILM/HPV(+) women are more likely to have repeat Pap, or cervical biopsy, in < 1 year in OBGYN vs IM practices (52% vs 0%). 6. Adolescents are overwhelmingly and inappropriately tested/triaged with HPV (84%). 7. Adolescents with LSIL often proceed unnecessarily to cervical biopsy in < 1 year (75%). 8. Approximately 40% of women >65 are screened for cervical cancer without indication. 9. Many HSILS are not followed by cervix biopsy or LEEP within 1 year (33%).
Category: Gynecologic & Obstetrics

Monday, March 22, 2010 11:00 AM

Platform Session: Section D, Monday Morning

 

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