Poor rates of surveillance follow-up noted in patients with high risk human papillomavirus and normal cytology

1. Among female patients with positive human papillomavirus (HPV) test results and negative intraepithelial lesion or malignancy (NILM) findings on cytology, less than half received the surveillance follow-up testing within the timeframe set forth by the 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines.

Evidence Rating Level: 2 (Good)

The current ASCCP guidelines for patients who receive a positive HPV test result and a normal NILM result recommend 2 consecutive negative annual results to return to routine screening. However, the feasibility of enforcing such guidelines is unclear. This cohort study therefore sought to investigate the adherence to surveillance testing and associated outcomes in patients with positive HPV results and negative NILM findings. 13158 patients (100% female, 24.5% hispanic, 15.1% African American, 5.7% asian, 49.8% non-hispanic white)  with an HPV-positive result and NILM-negative result were included from the PROSPR II Cervical Consortium which encompassed three hospital systems in the United States. Patients were assessed at round 1 (16 months after the index result) and if they had an HPV-negative result and NILM-negative result, were eligible to pass onto round 2 (an additional 16 months of surveillance). By the end of round 1, only 43.7% of patients were tested and only 18.2% of total patients (2394) had an HPV-negative result and NILM-negative result and were eligible to pass onto round 2. Groups less likely to test within the guideline-recommended timeframe were younger adults (aged 25-29 compared with 30-39 years: AOR, 0.65; 95% CL, 0.53-0.81), African American or Black patients (compared with White patients: AOR, 0.78; 95% CL, 0.68-0.89), as well as those with Medicaid (compared with commercial insurance: AOR, 0.81; 95% CL, 0.72-0.91). Among patients who were untested in round 1, 10 were found to have cancer and 54 had in situ cancer. Overall, this study found that among patients with an HPV-positive result and NILM-negative result, less than half received the recommended surveillance set forth by the 2019 ASCCP guidelines. 

Click to read the study in JAMA Network Open

Image: PD

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