Uptake of Co-Testing with HPV and Cytology for Cervical Screening: A Population-Based Evaluation in the United States

Authors

Jack Cuzick, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
Ruofei Du, University of New Mexico (UNM) Comprehensive Cancer Center, Department of Internal Medicine, Division of Molecular Medicine, Albuquerque, NM, USA
Rachael Adcock, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
Walter Kinney, Sacramento, CA, USA
Nancy Joste, UNM Health Sciences Center (HSC), Department of Pathology, Albuquerque, NM, USA
Ruth M. McDonald, UNM Health Sciences Center (HSC), Department of Pathology, Albuquerque, NM, USA; UNM Comprehensive Cancer Center, Center for HPV Prevention, Albuquerque, NM, USA
Kevin English, Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA
Salina M. Torres, New Mexico Department of Health, Albuquerque, NM, USA
Debbie Saslow, American Cancer Society (ACS), Atlanta, GA, USA
Cosette M. Wheeler, UNM Health Sciences Center (HSC), Department of Pathology, Albuquerque, NM, USA; UNM Comprehensive Cancer Center, Center for HPV Prevention, Albuquerque, NM, USA. Electronic address: cwheeler@salud.unm.edu

Document Type

Article

Publication Date

9-1-2021

Abstract

OBJECTIVES: Human papillomavirus (HPV) testing for cervical screening has been shown to increase the yield of precancerous disease and reduce the incidence of cervical cancer more than cytology alone. Here we document the state-wide uptake of co-testing with HPV and cytology in women aged 30-64 years as recommended by national and international bodies.

METHODS: Registry-based study of all screening cytology and HPV tests in New Mexico from 2008 to 2019 among women aged 21-64 years, with a focus on cytology negative tests to distinguish co-testing from reflex HPV testing to triage equivocal or mildly abnormal cytology.

RESULTS: A total of 1,704,055 cervical screening tests from 681,440 women aged 21-64 years in the state of New Mexico were identified. The proportion of screening tests which were co-tests rose from 5.6% in 2008 to 84.3% in 2019 among women aged 30-64 years with a marked change from the near exclusive use of the Hybrid Capture II HPV test, (a signal amplified test method) to the use of target amplified HPV tests. The largest increases were seen between 2013 and 2015, reflecting the introduction and adoption of new clinical guidelines. Increases in co-testing were also seen in younger women.

CONCLUSIONS: Co-testing is now well established in women aged 30-64 years, but smaller increases have also been seen at younger ages, although this is not currently recommended. The impact of co-testing on cervical disease outcomes and number of colposcopies and biopsies in routine population settings remain important, especially in young women.

Recommended Citation

Cuzick J, Du R, Adcock R, Kinney W, Joste N, McDonald RM, English K, Torres SM, Saslow D, Wheeler CM; New Mexico HPV Pap Registry Steering Committee. Uptake of co-testing with HPV and cytology for cervical screening: A population-based evaluation in the United States. Gynecol Oncol. 2021 Sep;162(3):555-559. doi: 10.1016/j.ygyno.2021.06.029. Epub 2021 Jul 10. PMID: 34253387; PMCID: PMC8405560.