Delivering Guideline-Concordant Care for Patients With High-Risk HPV and Normal Cytologic Findings

Area of Science:

• Gynecologic Oncology
• Public Health
• Epidemiology

Background:

• US healthcare is transitioning to human papillomavirus (HPV)-based cervical cancer screening.
• Patients with HPV-positive (non-16/18 genotypes) results and negative for intraepithelial lesion or malignancy (NILM) cytology require specific surveillance.
• Current guidelines recommend two consecutive negative annual results to return to routine screening.

Purpose of the Study:

• To quantify surveillance testing patterns in patients with HPV-positive results and NILM cytology.
• To assess the outcomes associated with these surveillance testing patterns.
• To identify factors influencing timely surveillance testing.

Main Methods:

• A cohort study analyzed data from the METRICS (Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings and Populations) cohort within the PROSPR II Cervical Consortium.
• Population-based data from three diverse US healthcare systems (Mass General Brigham, Kaiser Permanente Washington, Parkland Health) were used.
• The study included 13,158 female patients aged 21-65 years with HPV-positive (non-16/18) and NILM results from January 2010 to August 2018, followed through December 2019.

Main Results:

• Only 43.7% of patients received a surveillance cotest within 16 months of the initial HPV-positive result.
• Among those tested, 18.2% had HPV-negative/NILM results, and 25.5% had abnormal results.
• Factors associated with lower odds of timely testing included younger age (25-29 years), being non-Hispanic Black, and having Medicaid insurance; having a primary care clinician increased the likelihood of timely testing.

Conclusions:

• Less than half of patients with HPV-positive results and NILM cytology received recommended annual surveillance testing.
• Significant proportions of patients were either untested or lost to follow-up during the surveillance period.
• Healthcare systems need to actively monitor surveillance adherence and implement interventions to improve timely testing delivery for optimal cervical cancer prevention.