Statement on HPV DNA test utilization

Abstract

Testing for carcinogenic or high-risk human papillomavirus (HPV) DNA has proven utility in cervical cancer screening and in many aspects of clinical management for cervical cancer prevention. However, inappropriate testing increases costs without benefit and potentially results in over-treatment of women. This Statement was developed by the Cytopathology and Technology Education Consortium and has been endorsed by additional professional medical societies as listed below. It is intended as a concise, convenient summary of clinical indications for HPV DNA test utilization based on the American Cancer Society 2002 screening recommendations1 and interim guidance2, and the 2006 American Society for Colposcopy and Cervical Pathology (ASCCP) consensus management guidelines3. Circumstances in which HPV DNA testing is considered appropriate, and when such testing is generally not appropriate, are outlined below. This statement is intended to serve an educational tool and reference to improve management of women and reduce inappropriate use of HPV tests. High-risk (oncogenic) HPV DNA testing is appropriate in the following circumstances: 1.1 Routine cervical cancer screening in conjunction with cervical cytology (dual testing or co-testing) for women 30 years and older: 1.1.1 For women who are cytology-negative but HPV positive, repeat both tests in 12 months 1.1.2 For women who are both cytology and HPV negative, repeat both tests only after a 3-year interval 1.2 Initial triage management of women 21 and older with a cytologic result of ASC-US 1.3 Initial triage management of post-menopausal women with cytologic result of LSIL 1.4 Post-colposcopy management of women of any age with initial cytologic result of Atypical Glandular Cells*(AGC) or ASC-H (when initial workup does not identify a high grade lesion) 1.5 Post-colposcopy management of women 21 and older with initial cytologic results of ASC-US or LSIL (when initial colposcopy does not identify a high grade lesion) 1.6 Post-treatment surveillance. High-risk (oncogenic) HPV DNA testing is generally NOT appropriate in the following situations: 2.1 Routine cervical cancer screening in women less than 30 years of age 2.2 Routine screening with HPV testing and cervical cytology more often than every 3 years for women 30 years and older whose tests were negative at last screen (see 1.1.2 above) 2.3 Initial triage or management of adolescents (age 20 and younger) with any abnormal cytologic result. Further, if HPV testing is inadvertently performed, the results should not be used to influence patient management 2.4 Initial triage of LSIL (except for post-menopausal women; see 1.3 above) 2.5 Initial triage of ASC-H, HSIL or AGC*/AIS in women of any age Repeat high-risk (oncogenic) HPV DNA testing should generally not be done in less than 12 months: 3.1 Exceptions include follow-up to AGC NOS when no pathology is found at initial workup, and follow-up after treatment for CIN 2,3. See ASCCP Guidelines for specific recommendations on testing intervals.3 Testing for low-risk (non-oncogenic) HPV types has NO role in routine cervical cancer screening or for the evaluation of women with abnormal cervical cytology. Endorsed by the: American Cancer Society #American Society for Clinical Pathology American Society for Colposcopy and Cervical Pathology #American Society of Cytopathology #American Society for Cytotechnology #College of American Pathologists #International Academy of Cytology #Papanicolaou Society of Cytopathology # Indicates member of the Cytopathology Education and Technology Consortium The intent of this summary is to facilitate provider education and to encourage appropriate utilization of HPV testing. Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible to develop guidelines that apply to all situations. Links to the 2006 ASCCP Consensus Guidelines, as well as management algorithms, are available on the ASCCP website at http://www.asccp.org/consensus/cytological.shtml.