HPV co-testing guidelines: Are you adhering?

Among ob/gyns and family medicine practitioners, adherence to human papillomavirus (HPV) co-testing guidelines for cervical cancer screening in women age 30 to 65 years has not been universally adopted, even though this has been deemed the preferred screening method.

This lack of adherence to the American College of Obstetricians and Gynecologists (ACOG) 2013 recommended guidelines, which call on all providers to utilize co-testing as the preferred method of screening for these patients, was underscored by new findings presented in an e-poster at the ACOG 2016 annual meeting. HPV co-testing is a combination screening method utilizing both Pap cytology and HPV DNA testing.

The e-poster presentation was made by Dr. Ashley Einck and Dr. Catherine Cansino of the University of California Davis, Medical Center, Fair Oaks. It describes the results of their retrospective cohort study undertaken to analyze guideline adherence for all providers and to compare adherence rates between ob/gyn and family medicine practitioners.

Included in the study population were 1267 women, age 21 to 65 years, who presented at outpatient clinics of the UC Davis Medical Center for a routine gynecologic visit between September 2013 and January 2014. During their visit, all study participants had had cervical cytology performed. They also had completed their previous cervical cytology within this health system.

Of the total cohort, 991 women were patients of family medicine physicians and 276 were patients of ob/gyns. Results showed that adherence to preferred HPV co-testing recommendations for women who were age eligible was 62.47% for those practicing family medicine and 71.97% for those practicing as ob/gyns (P<.01).

Further, the researchers found that documentation of having been given the HPV vaccine was only available for 9.28% in family medicine and 2.09% in ob/gyn care (P<.001), for an overall total of 7% of patients with such documentation. This finding showed that assessment by practitioners of the HPV vaccination history of their patients was inadequate.

The investigators note that the overall proportion of patients undergoing HPV co-testing did increase during the course of their study (P=.06). They stress, however, that given their results on nonadherence, it is essential physicians caring for women 30 years and older receive information about the 2013 screening guidelines for cervical cancer. Their understanding of the importance of vaccination and the role of preferred HPV co-testing in this age group is clearly needed to improve physician adherence and thereby aid in the prevention of cervical cancer.

Screening guidelines for cervical cancer have also included that genotyping for HPV type 16 alone or HPV types 16 and 18 can be used as an adjunct in women who have negative Pap test results, but who have tested positive for high-risk HPV by an assay testing for 13 or 14 high-risk types.

For the latest updates to ACOG’s cervical cancer screening guidelines, see its “Practice Bulletin No. 157: Cervical Cancer Screening and Prevention” (Obstet Gynecol. 2016;127:e1–e20), January 2016.