CDC Finds Few Follow HPV Recommendations


CHARLESTON, S.C. — Most ob.gyns. are ordering human papillomavirus testing for borderline Pap test results as recommended, but a substantial number are using the HPV test for nonrecommended purposes, or are ignoring other recommendations for the testing, a Centers for Disease Control and Prevention survey shows.

Current recommendations of several U.S. organizations, including the CDC, the American College of Obstetricians and Gynecologists, and the American Cancer Society, support HPV testing to help guide management in patients with Pap test results showing atypical squamous cells of undetermined significance (ASCUS). Both ACOG and the ACS also endorse HPV testing in those over 29 years old to identify infected women who might benefit from frequent follow-up Pap testing, Zsakeba Henderson, M.D., of the CDC, Atlanta, said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

These uses for the HPV test, which tests for oncogenic HPV types, have been approved by the Food and Drug Administration, she noted.

To determine the effects of the HPV testing guidelines on clinical practice, the CDC surveyed 3,339 physicians and midlevel clinicians who provide cervical cancer screening. Respondents included 464 ob.gyns., of whom 93% reported ever using the HPV test.

Of those, nearly all (99.6%) said they used it for ASCUS Pap test results as recommended. However, many were also using HPV testing for patients with Pap test results showing higher-grade lesions; 84% said they used it for atypical squamous cells results (cannot exclude high-grade squamous intraepithelial lesions); 61% said they used it for low-grade squamous intraepithelial lesions results; and 46% said they used it for high-grade squamous intraepithelial lesions results, Dr. Henderson noted.

Additionally, many of the ob.gyn. respondents used the test for nonrecommended purposes, including in patients with anogenital warts (26%), as a primary screen for HPV infection (28%), and to test for HPV in patients with other STDs (32%).

Only 37% reported ordering HPV testing as an adjunct to Pap testing in women older than 29 years as recommended; as many who were using it for this purpose in the over-29 population were using it for screening in those aged 29 and younger, Dr. Henderson said.

But ob.gyns. who participated in the survey are doing better as a group, compared with other survey respondents, in regard to following the recommendations, she noted.

Overall, only 59% of the 3,339 survey respondents had ever used the HPV test (compared with 93% of ob.gyns.), about half of those used it for guiding management of ASCUS Pap test results (compared with nearly all of the ob.gyns. using the HPV test), and only 21% used it as an adjunct to Pap testing in women over 29, compared with 37% of ob.gyns.

Nonrecommended uses in the overall survey population included testing of sexual partners of women with an STD, as an alternative to Pap testing, and upon request of the patient to determine HPV status.

The CDC is using the survey findings to develop clinical training programs, decision support materials, and patient education materials, Dr. Henderson said.

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