Primary HPV Testing Recommendation Among US Physicians

HPV, stethoscope, glass vials
HPV, stethoscope, glass vials
Many US physicians recommended primary HPV testing for women of all ages, contrary to guidelines which limit this screening approach to women ≥25 years old.

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).

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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.”


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