Uptake of HPV testing and extended cervical cancer screening intervals following cytology alone and Pap/HPV cotesting in women aged 30–65 years
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To evaluate the adoption of HPV testing and recommended extended cervical cancer screening intervals in clinical practice, we described yearly uptake of Pap/HPV cotesting and estimated length of time between normal screens by patient characteristics.
We examined 55,575 Pap/HPV records from 27,035 women aged 30–65 years from the Johns Hopkins Hospital Pathology Data System between 2006 and 2013. Cotest uptake and median times to next screening test for cotests and cytology only were calculated. Adjusted hazard ratios were estimated using Cox proportional hazards models, with random effects adjustment for clustering within clinic.
Cotest usage increased from < 10% in 2006 to 78% in 2013. The median time to next screening test following normal cytology alone remained constant around 1.5 years. Screening intervals following a dual-negative cotest increased from 1.5 years in 2006/2007 to 2.5 years in 2010, coincident with increases in the proportion of women cotested. Intervals following a dual negative cotest were longer among Medicare patients (3 years) compared with privately insured women (2.5 years), and shorter among black (2 years) compared with white women (2.8 years).
By mid-2013 we observed broad adoption of Pap/HPV cotesting in routine screening in a large academic medical center. Increased screening intervals were observed only among cotested women, while those screened by cytology alone continued to be screened almost annually. The influence of different combinations of race and insurance on screening intervals should be further evaluated to ensure balance of screening risks and benefits in the U.S. population.
KeywordsCervical cancer screening Cytology HPV cotest Screening guidelines Screening interval Implementation Dissemination
The authors wish to thank Amy Tatsas, John Boitnott and the Johns Hopkins Hospital Department of Pathology. They also thank Nicole A. Patterson for assistance with the graphics.
This work was supported by the Agency for Healthcare Research and Quality (R36 HS022199 to MIS), the National Cancer Institute (Specialized Program of Research Excellence in Cervical Cancer- 2P50-CA098252-11 to AFR and R01 CA123467 to PEG). This work was also supported by the Maryland Cigarette Restitution Fund Research Grant to the Johns Hopkins Medical Institutions (FY15 to AFR) and the Johns Hopkins Individualized Health Initiative (Hopkins inHealth to DFP).
Conceptualization: MS, PG; Methodology: MS, AR, DPE, PG; Software: MS; Validation: MS, PG; Formal Analysis: MS; Investigation: MS; Resources: MS, DPE, PG; Data Curation: MS; Writing-original draft: MS; Writing- review & editing: MS, AR, DPE, PG; Visualization: MS, PG; Supervision: PG; Project Administrator: MS; Funding Acquisition: MS, PG.
Compliance with ethical standards
Conflict of interest
The authors declare no conflicts of interest.
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