Five-year experience of human papillomavirus DNA and Papanicolaou test cotesting

Abstract

Objective: To estimate the 5-year age group-specific test positives for Pap tests and human papillomavirus (HPV) testing in a large, general screening population of women 30 and older.

Methods: Using data from Kaiser Permanente Northern California, a large health maintenance organization that introduced cotesting in 2003, we evaluated the cotesting results overall and by 5-year age groups. Women (n=580,289) who opted for and underwent cotesting (n cotests=812,598) between January 2003 and April 2008 were included in the analysis. Pap tests interpreted as atypical squamous cells of undetermined significance (ASC-US) or more severe were considered to be positive. Women were tested for carcinogenic HPV using an assay approved by the U.S. Food and Drug Administration. Binomial exact 95% confidence intervals (CIs) were calculated.

Results: Overall, 6.27% (95% CI 6.21-6.32%) of cotests were carcinogenic HPV positive, and only 3.99% (95% CI 3.94-4.03%) cotests had normal cytology and were carcinogenic HPV positive. By comparison, 5.18% (95% CI 5.13-5.23%) of cotests had ASC-US or more severe cytology, and 2.87% (95% CI 2.84-2.91%) of cotests had ASC-US or more severe cytology and were carcinogenic HPV negative.

Conclusion: In a general screening population, concerns about excessive HPV test positives among women aged 30 years and older are not borne out.

Figure 1

Percentage of woman with normal Papanicolaou (Pap) tests who tested positive for carcinogenic human papillomavirus (HPV) by Hybrid Capture 2 (hc2+) by age group (black squares) and for all women 30 and older (white squares). Data from the Kaiser Permanente Northern California Health Plan from January 2003 through April 2008.