Primary HPV Testing Recommendation Among US Physicians

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The Pap test alone and co-testing remained the dominant cervical cancer screening modalities recommended by providers, but >40% recommended primary HPV testing.
The Pap test alone and co-testing remained the dominant cervical cancer screening modalities recommended by providers, but >40% recommended primary HPV testing.

US physicians routinely recommended primary HPV testing for all women, contrary to guideline recommendations to limit this strategy to women age ≥25, according to research published in Preventive Medicine.

Data were gathered using an online survey in 2015.  Participants included were primary care physicians and obstetrician-gynecologists in the United States who actively saw patients, were in practice for the last 3 years, and routinely performed cervical cancer screening. In total 843 (601 primary care physicians and 242 obstetrician-gynecologists) participants were asked which screening options (Pap tests alone, HPV tests alone or both) and screening intervals they recommended for average risk asymptomatic women in age groups, ≤24, 25-29 and, ≥30.

 

Primary HPV tests were recommended by 40.8% of physicians to women ≥30 years old and, of these, 90.1% also recommended them to all age groups. Pap tests alone were the most recommended option for women age <25 years (81.4%) and 25-29 (80.9%). Recommendations for both tests were most common for women ≥30 years old (94.4%) and the most common screening intervals were every 3 years (35.5%) and annually (30.2%).

In the bivariate analyses, the investigators found that the following provider characteristics influenced routine recommendation of primary HPV testing for average-risk, asymptomatic women age ≥30: internists, male providers, and providers who reported that their cervical cancer screening practices were influenced by patient preference or patient HPV vaccination status (P <.001 for all).

Patient HPV vaccination status was the strongest predictor of routine recommendation of primary HPV testing in the adjusted model (adjusted odd ratio 3.96; 95% CI 2.82-5.57).

Since providers were asked about their screening recommendations in a hypothetical context, one of the key limitations of this study was an inability to decipher how the recommendation of primary HP testing translated into actual use. But the self-reported responses suggest that "primary HPV testing in the United States may be out of sync with current guidelines," noted the researchers.

The investigators cautioned that “over-screening with the HPV test is associated with greater peril than over-screening with the Pap test” and is a public health concern because “increased detection of transient HPV infections, particularly in younger women, will augment unnecessary diagnostic procedures and follow-up.”

Reference

Cooper CP, Saraiya M. Primary HPV testing recommendations of US providers, 2015Prev Med. 2017; 105: 372-377.

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