HPV Follow-up Testing Falls Short

TOPLINE: 

Fewer than half of patients testing positive for HPV received recommended annual follow-up testing, a new cohort study found. Healthcare systems should track surveillance rates and research interventions to improve follow-up care, the authors concluded.

METHODOLOGY:  

• Healthcare systems are shifting toward primary HPV screening and co-testing, making HPV-positive results with negative intraepithelial lesion or malignancy (NILM) cytologic findings a common screening abnormality.
• Guideline-concordant practice requires annual surveillance co-testing to monitor HPV persistence and potential progression of cervical dysplasia.
• Researchers analyzed data from three diverse healthcare systems: Mass General Brigham in Massachusetts, Kaiser Permanente Washington in Washington, and Parkland Health in Texas.
• A total of 13,158 female patients aged 21-65 years who tested positive for HPV and had NILM cytologic findings were followed from January 2010 to August 2018.
• Analysis included sociodemographic characteristics varying by site, with more non-Hispanic White and commercially insured patients at Kaiser Permanente Washington and Mass General Brigham and more Hispanic or Latine and uninsured patients at Parkland Health.
• Primary outcome measures focused on test receipt and outcomes delivered within 16 months after the index result.

TAKEAWAY:  

• During round 1 surveillance, 43.7% of patients were tested, with 18.2% testing negative for HPV and having NILM cytologic findings, whereas 25.5% had abnormal results.
• Groups with lower odds of timely testing included younger adults aged 25-29 years vs 30-39 years (adjusted odds ratio [AOR], 0.65; 95% CI, 0.53-0.81) and non-Hispanic African American or Black patients vs non-Hispanic White patients (AOR, 0.78; 95% CI, 0.68-0.89).
• Patients with Medicaid vs commercial insurance had lower odds of timely testing (AOR, 0.81; 95% CI, 0.72-0.91), whereas those with a primary care clinician were also more likely to receive timely testing (AOR, 1.44; 95% CI, 1.21-1.70).
• Cancer was diagnosed in 10 patients (0.2%) who were untested in round 1 surveillance, compared with zero cases of cancer among those who had HPV-negative results and NILM cytologic findings.

IN PRACTICE:

“Collectively, the data showed low-level adherence to the annual surveillance regimen recommended by [the American Society for Colposcopy and Cervical Pathology] guidelines and suggest that abnormal HPV-positive results and NILM cytologic findings may be challenging for health care systems to track and follow to resolution. This challenge may have serious consequences given that these patients have a 0.55% to 3.99% 5-year risk of developing [cervical intraepithelial neoplasia grade 3] or worse,” wrote the study authors.

SOURCE:

The study was led by Jasmin A. Tiro, PhD, Department of Public Health Sciences, Division of Biological Sciences, The University of Chicago. It was published online on January 17 in JAMA Network Open.

LIMITATIONS:

Data represented only three geographically distinct healthcare systems and are not representative of the United States or specific regions. Patients who disenrolled or left a healthcare system may have received follow-up elsewhere, potentially underestimating surveillance rates. Additionally, the index HPV-positive result and NILM cytologic finding may not have been a patient’s first sign of HPV infection because 13.6% of patients were under surveillance with prior abnormal findings. Some healthcare systems modified elements of the American Society for Colposcopy and Cervical Pathology guidelines, such as by allowing 3-year follow-up after an initial negative result.

DISCLOSURES:

The study received support through grant UM1CA221940 from the National Cancer Institute, National Institutes of Health, and grant CRP-22-080-01-CTPS from the American Cancer Society. Tiro reported receiving a grant from the National Cancer Institute during the study. Co-author Sarah Feldman, MD, disclosed receiving personal fees from UptoDate outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.