HPV Testing in Cervical Cancer Screening: Time Trends and Evidence-Based Practice

Johns Hopkins University, Baltimore MD

Investigators

Abstract

[unreadable] DESCRIPTION (provided by applicant): The overarching objective of this research is to describe time trends and identify potential barriers to use of human papillomavirus (HPV) DNA testing in routine cervical cancer screening practice. High-risk HPV infection is a necessary, but insufficient cause of cervical cancer. A preponderance of evidence supports the use of HPV DNA testing in cervical cancer screening of women 30 years and older to improve the cost- effectiveness of cervical cancer prevention. However, little is known about actual provider use of the test. Rapid assessment of HPV DNA testing uptake in routine cervical cancer screening is directly responsive to the CDC's Health Protection Goal of `Healthy People at Every Stage in Life,' specifically starter objectives among adults, older adults, and the elderly, as related to chronic disease prevention, infectious diseases prevention, and increasing the number of individuals who receive preventive health services. Cervical cancer rates continue to reflect racial and socio-economic disparities and this research will focus on a CDC priority population, women, including low-income groups, minority groups, and the elderly. To examine provider use of HPV DNA testing in routine cervical cancer screening, provider practice data collected at Johns Hopkins Hospital & Health System in Baltimore, Maryland from 2001-2006 will be utilized. The Division of Cytopathology will provide cross-sectional specimen record data and associated de-identified patient information. Provider information will be purchased, de-identified, and appended to the appropriate specimen record. Specific Aim 1 will assess temporal trends of HPV DNA testing in women 30 years and older and will compare these trends with the uptake of HPV DNA testing for follow-up of abnormal Pap test results of undetermined significance (i.e., ASC-US triage). Specific Aim 2 will identify provider and patient characteristics associated with evidence-based and non-evidence based use of HPV DNA testing in general screening. This research will establish baseline screening practices prior to wide HPV vaccine coverage and release of updated screening guidelines. Identifying current factors related to appropriate practices may allow for preemptive intervention, if needed, for future guideline changes. If HPV DNA testing fails to be properly used in screening for women 30 years and older and annual Pap testing is maintained as the status quo, the US will divert critical health care dollars away from more pressing needs in this large, aging population. Broad uptake of HPV DNA testing in routine screening of women 30 years and older is critical for continuing the decline in cervical cancer incidence without inflating the cost of its prevention. In order to achieve the most cost-effective combination of screening and HPV vaccination, it's crucial to monitor and characterize the uptake of HPV DNA testing in routine screening. [unreadable] [unreadable] [unreadable] [unreadable]