Low-Risk Human Papillomavirus Testing and Other Nonrecommended Human Papillomavirus Testing Practices Among U.S. Health Care Providers

Abstract

To assess self-reported human papillomavirus (HPV) DNA testing practices by health care providers and clinics, including nonrecommended practices such as low-risk HPV testing, HPV cotesting in women younger than age 30 years, and HPV reflex testing for high-grade abnormal Pap test results. We analyzed responses to a cross-sectional survey of a nationally representative sample of Papanicolaou test providers administered in conjunction with the 2006 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Data analysis was performed on responses from 376 office-based health care providers and 216 outpatient clinics. Overall, 75.5% (95% confidence interval [CI] 68.7-81.2%) of health care providers and 77.2% (95% CI 60.3-88.3%) of clinics reported ever using the HPV DNA test. Of health care providers who used HPV testing, 28.5% (95% CI 21.6-36.6%) used both high-risk and low-risk HPV tests. Most health care providers (59.6%, 95% CI 48.5-69.7%) and clinics (66.0%, 95% CI 48.0-80.3%) used HPV cotesting in women younger than age 30 years. A high percentage of health care providers and clinics performed reflex HPV testing after Pap test results of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (71.4%, 95% CI 63.5-78.3% and 62.8%, 95% CI 49.0-74.9%, respectively) and high-grade squamous intraepithelial lesions (50.7%, 95% CI 42.4-58.9% and 49.0%, 95% CI 33.1-65.2%, respectively), results for which HPV testing is not recommended. Many health care providers reported inappropriate uses of HPV testing, which may lead to unnecessary follow-up and increased medical costs without added benefits. Interventions such as eliminating the low-risk HPV test from the U.S. market and educating health care providers and patients on appropriate indications for HPV testing are needed to discourage health care providers from such practices.