Role of adjuvant HPV testing and continued Pap smear screening in women over age 6

Abstract

1531 Background: A rural comprehensive cancer screening program at Audrain Medical Center in Mexico, Missouri, provides early detection, education, and cancer prevention for women primarily over the age of 40 and men over the age of 50. The cancer screening examination for women includes a head to toe skin examination, clinical breast exam, screening mammography, liquid-based Pap test, and pelvic examination. In addition, a site-specific physical examination of the abdomen, thyroid, peripheral lymph nodes, digital rectal exam, and fecal occult blood testing offered to all over age 50. Methods: A retrospective review of all abnormal Pap smears and HPV results were evaluated during a 12-month time frame (2005–2006 calendar year). During this study period, 2611 women were screened for cervical cancer using the liquid based Pap smear. Characteristics which were reviewed included all ASCUS and LGSIL pap, percentage of abnormal results in the over age 65 group verses under age 65, and percentage of positive HPV tests. Standard protocol is to order a reflex high risk HPV on all ASCUS and LGSIL Pap smear test results. The age range for this population was 28 to 90 with the median age 53. Results: During the 12 month study time, 64 out of 2611, or 2.4% abnormal Pap smear reports were identified. Out of those 64, there were 37 (57.8%) ASCUS and 27 (42.1%) LGSIL Paps and 10 positive (15%) high-risk HPV results with 2 positive HPV (3.1%) being in women over age 65. Further break down by age revealed 13 (20%) of the ASCUS paps, and 6 (9.3%)LGSIL were in women over age 65, for a total of 19 (29.3%) of abnormal Pap smears in women over age 65. Conclusions: As women grow older the incidence of HPV infections become less, however the occurrence of cervical cancer increases. Therefore, continued Pap smear screening in older women with adjuvant high risk HPV testing can identify those women who need further invasive intervention for cervical cancer prevention. No significant financial relationships to disclose.