Abstract B92: HPV and Pap test results among low-income, underserved women: Providing insights into management strategies

Abstract

Abstract Objective: Human papillomavirus (HPV) DNA testing combined with cytology (co-testing) has been recommended as a primary cervical cancer screening strategy and will be covered as a preventive service by the Affordable Care Act (ACA). Women with discordant results (HPV positive/cytology negative) present significant management challenges and result in additional costs due to follow-up visits and testing required. The frequency of discordant results in insured populations is at a level that does not negate the benefit of co-testing. However, it is unknown if the frequency of discordant results would be the same for underserved women, who may have more risk factors for HPV infection and cancer precursors. Methods: The Centers for Disease Control and Prevention's Cervical Cancer (Cx3) Study was conducted at 15 clinics in 6 Federally Qualified Health Centers (FQHCs) across Illinois. Providers at these clinics were given the option of co-testing for routine cervical cancer screening. Clinical high-risk HPV testing was performed using the FDA approved Hybrid Capture 2 assay (HC2: Qiagen). An additional research test to determine type-specific HPV results was performed on residual extracts. Results: Testing was completed on 2246 underserved women, mean age 45.1 years. The HPV test was positive in 7.2% and cytology abnormalities were detected in 6.0% with discordant results in 4.9% of women. The percentage of HPV positive tests decreased with age, from 10.3% among 30-39 year olds to 4.5% among 50-60 year olds. Among women with negative normal Pap test results who where high risk positive, 14% of the women were positive for HPV 16/18 while the remaining were positive for other high risk types. Conclusion: The rate of discordant co-testing in this study of underserved women was similar to those reported throughout the U.S. in different populations, including those who are insured. Similarly, the lower percentage of discordant results and those positive for HPV 16/18 may favor a more conservative management strategy than an aggressive strategy of immediate colposcopy. Citation Format: Mona Saraiya, Vicki Benard, April Greek, Martin Steinau, Sonya Patel, Diane Manninen, George Sawaya, Stuart Massad, Elizabeth Unger. HPV and Pap test results among low-income, underserved women: Providing insights into management strategies. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B92. doi:10.1158/1538-7755.DISP13-B92