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Statement on HPV DNA Test Utilization

As published by Solomon et al. in ACTA CYTOLOGICA 2009, 53:247-248

Testing for human papillomavirus (HPV) DNA has proven utility in many aspects of clinical management for cervical cancer prevention. However, inappropriate testing results in excessive costs and potentially over-treatment of women. This Statement, endorsed by the societies listed below, 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 guidelines², 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 over-testing.

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.

1. 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)
Info1.6. Post-treatment surveillance.

2. 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
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 postmenopausal women)
2.5. Initial triage of ASC-H, HSIL or AGC^*/AIS in women of any age

3. 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 work-up, and follow-up after treatment for CIN 2,3. See ASCCP Guidelines for specific recommendations on testing intervals.³

4. 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.

 

^*Note that for AGC results, HPV testing is not to be used for triage to decide whether to refer to colposcopy; however HPV testing may be done at the time of colposcopy to guide post-colposcopy management

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

The intent of this summary is to facilitate provider education and to encourage appropriate utilization of HPV testing. The 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Screening Tests should never substitute for clinical judgment. 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. Complete guidelines and management algorithms may be viewed online at http://www.asccp.org

Reference

1. Saslow D, Runowicz CD, Solomon D, Moscicki AB, Smith RA, Eyre HJ, and Cohen C. American Cancer Society Guideline for Early Detection of Cervical Neoplasia and Cancer. 2002;52:342-362.

2. Wright TC Jr., Schiffman M, Solomon D, Cox JT, Garcia F, Goldie S, et al. Interim guidance for the use of human papillomavirus DNA testing as an adjunct to cervical cytology for screening. Obstet Gynecol 2004;103:304-9.

3. Wright, Massad, Dunton, Spitzer, Wilkinson, Solomon; for the 2006 ASCCP-Sponsored Consensus Conference,

2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Screening Tests,

Journal of Lower Genital Tract Disease 2007;11(4):201-222 and American Journal of Obstetrics and Gynecology 2007;197(4);346-355.