Timely surveillance reported in under half of HPV-positive patients

Timely surveillance reported in under half of HPV-positive patients | Image Credit: © Beate Panosch - © Beate Panosch - stock.adobe.com.

A surveillance cotest within the guideline-recommended time frame is only provided to under half of patients with human papillomavirus (HPV)-positive results and negative for intraepithelial lesion or malignancy (NILM) cytological findings, according to a recent study published in JAMA Network Open.¹

In 2019, the American Society for Colposcopy and Cervical Pathology (ASCCP) released guidelines to “ensure equal management for equal risks” for managing abnormal cervical cancer screening results.² However, adverse outcomes and cervical cancer disparities may occur from uneven implementation of these guidelines, according to researchers.¹

Investigators identified screening history and risk factor data and continued engagement with health care systems as vital elements of guideline application. Therefore, a study was conducted to determine how well practice for HPV-positive result and NILM cytologic finding aligns with guidelines.

Kaiser Permanente Washington (KPWA), Mass General Brigham (MGB), and Parkland Health (PH) participated in the analysis. Health care use, sociodemographic data, pregnancy status, procedure dates and results, cytologic and HPV test dates and results, and cancer diagnoses were obtained from electronic health records.

Participants were aged 21 to 65 years and entered the cohort between January 2010 and August 2018. Surveillance lasted through December 2019. Patients with positive test results with screening specifically for HPV 16/18 were excluded from the analysis. NILM cytologic findings and positive results for 12 to 14 high-risk HPV genotypes were assessed.

There were 13,158 patients with positive findings included in the analysis, representing 17.2% of all index abnormal results. Of patients, 24.5% were Hispanic, 15.1% non-Hispanic Black, 5.7% non-Hispanic Asian, 49.8% non-Hispanic White, 3.1% other or multiple races, and 1.7% unknown race and ethnicity.

Similar sociodemographic characteristics were reported between the HPWA and MGB cohorts. However, the PH cohort was more likely to be older, Hispanic, uninsured or covered by government programs, and living in a Census-tract with high area-level poverty.

Testing by the end of round 1 surveillance was only reported in 43.7% of patients, with 18.2% having a negative finding and 25.5% an abnormal result. Overall, 49.4% were untested despite remaining enrolled, while 6.9% exited the cohort without being tested.

A second negative result among patients eligible for round 2 testing was reported in only 11.4%, while an abnormal result was identified in 6.5%. Being untested was reported in 60.1% and exiting before the end of the 16-month window in 22.1%.

Different patterns were reported based on the health care system. Approximately 25% of KPWA patients exited before the end of round 1 surveillance, and 69.4% of PH patients were untested during round 1 surveillance. The highest rates of negative findings were reported in the MGB cohort at 22.9% in round 1 and 15.4% in round 2.

Being aged 25 to 29 years vs 30 to 39 years, Black vs White, and with Medicaid vs commercial insurance were linked to reduced odds of testing during round 1, with adjusted odds ratios (AORs) of 0.65, 0.78, and 0.81, respectively. The odds of timely testing were greater in patients with a primary care clinician, with an AOR of 1.44.

The AOR for timely surveillance in the KPWA and PH cohorts vs the MGB cohort was 0.63, indicating significantly reduced odds. Approximately 40% of patients were untested in round 1 and remained untested through the end of the cohort period.

These results indicated less than half of patients with HPV-positive results and NILM cytologic findings receive an initial surveillance cotest at 1 year. According to investigators, “unintended, poor cancer outcomes may result.”

References

1. Tiro JA, Lykken JM, Chen PM, et al. Delivering guideline-concordant care for patients with high-risk HPV and normal cytologic findings. JAMA Netw Open. 2025;8(1):e2454969. doi:10.1001/jamanetworkopen.2024.54969
2. Perkins RB, Guido RS, Castle PE. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020;24(2):102-131. doi:10.1097/LGT.0000000000000525