Female Providers, Residents More Likely to Order HPV Testing for Low-Risk Women

Female providers were twice as likely as their male counterparts to order human pappilomavirus (HPV) testing for low-risk women aged 30 to 65 years who had normal Pap smear results, according to an audit of cytology request forms from 5 Michigan medical clinics. Granted, these results do not reflect the practices of ob/gyns, but they are of interest nonetheless.

The audit, which included reviewing 833 forms from January 2008 to April 2011, is the basis of research published in the current issue of the Journal of the American Board of Family Medicine.

Researchers from the University of Michigan Health System also found that while HPV co-testing for any cytology results remained modest with just 39% ordering the test, the practice did increase over time. Annual requests grew 46%, including HPV testing for any cytology result after adjusting for faculty provider sex, according to the study.

In addition, the researchers noted residents and fellows were the most likely to order HPV testing, with 48% doing so. As a plausible explanation, the authors pointed out that residents and fellows might have more current training on gynecology and screening guidelines. Faculty requested the testing 38% of the time and nurse practitioners and physician assistances only ordered the testing 10% of the time.

"Cervical cancer has moved from being a molecular issue to an infectious issue and this whole concept of testing someone with normal cells in the cervix changes the paradigm on how you communicate with patients about HPV tests, and how and when to use them," said Mack Ruffin IV, MD, MPH, one of the authors and professor of family medicine at the U-M Medical School, in a statement. "As HPV testing becomes more frequent, this data helps us identify differences in care that we can improve in the future."

The authors said additional study was needed to examine why male doctors and faculty members were less likely to test for the common sexually transmitted disease, but their findings indicate which providers to target as efforts to shift the paradigm of HPV testing continue.

"Cervical cancer can be the most preventable cancer in women. Current strategies using co-testing with Pap and HPV tests are a well-received and cost-effective option for screening low-risk women," said Alisa Young, MD, a clinical lecturer in the U-M department family medicine and coauthor on the paper, in a statement.

Pertinent Points:
- Female providers were twice as likely than their male counterparts to order HPV testing for low-risk women aged 30 to 65, according to a study.
- Residents and fellows were the most likely to order the HPV testing.
- HPV co-testing for any cytology results increased annually, according to the study.

References:

de la Cruz MSD, Young AP, Ruffin MT IV. Human papillomavirus (HPV) testing for normal cervical cytology in low-risk women aged 30-65 years by family physicians. J Am Board Fam Med. 2013;26:720-727.