Details:

Alternative Title:
Am J Obstet Gynecol
Publisher's site:
http://dx.doi.org/10.1016/j.ajog.2014.05.001
Personal Author:
Saraiya, Mona ; Benard, Vicki B. ; Greek, April A. ; Steinau, Martin ; Patel, Sonya ; ... More +
Saraiya, Mona ; Benard, Vicki B. ; Greek, April A. ; Steinau, Martin ; Patel, Sonya ; Massad, L. Stewart ; Sawaya, George F. ; Unger, Elizabeth R. Less -
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.


Subject:
[+]
Adult
Cervical Intraepithelial Neoplasia
Cross-Sectional Studies
Early Detection Of Cancer
Female
Humans
Middle Aged
Papanicolaou Test
Papillomavirus Infections
Poverty
Prospective Studies
Uterine Cervical Neoplasms
Vaginal Smears
Vulnerable Populations

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
Place as Subject:
Illinois
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:1644acb8b4ef71e7cccdaa7964c2d02b652731226ece7487472b9ebd9ab9c097
File Type:

Supporting Files

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