Type-specific HPV and Pap test results among low-income, underserved women: providing insights into management strategies

Details

• Alternative Title:
  Am J Obstet Gynecol
• Personal Author:
  Saraiya, Mona ; Benard, Vicki B. ; Greek, April A. ; Steinau, Martin ; Patel, Sonya ; Massad, L. Stewart ; Sawaya, George F. ; Unger, Elizabeth R.
• Description:
  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.
  
  
• Subjects:
  Adult Article Cervical Intraepithelial Neoplasia Cotesting Cross-Sectional Studies Early Detection Of Cancer Female Genotying HPV Testing Humans Illinois Middle Aged Papanicolaou Test Papillomavirus Infections Pap Test Poverty Prospective Studies Underserved Populations Uterine Cervical Neoplasms Vaginal Smears Vulnerable Populations

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• Source:
  Am J Obstet Gynecol. 211(4):354.e1-354.e6
• Pubmed ID:
  24813971
• Pubmed Central ID:
  PMC4386593
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Volume:
  211
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:1644acb8b4ef71e7cccdaa7964c2d02b652731226ece7487472b9ebd9ab9c097
• Download URL:
  https://stacks.cdc.gov/view/cdc/30359/cdc_30359_DS1.pdf
• File Type:
  [PDF - 227.16 KB ]