College of American Pathologists
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  Are physicians following the guidelines?


CAP Today




October 2010
Feature Story

Among those familiar with the data, it is widely acknowledged that validated testing for high-risk human papillomavirus genotypes can improve the accuracy of cervical cancer screening while lowering risk and cost. Yet people working in this field have a strong impression that most clinicians are not ordering automatic testing for hrHPV in conjunction with a Pap test in women age 30 and over, as guidelines recommend.

“The guidelines recommending HPV testing are relatively new,” says William Watkin, MD, chief of anatomic pathology in the Chicago area’s NorthShore University HealthSystem. “Still, it’s kind of curious that a lot of clinicians are not familiar with the guidelines since they were published in their own journals.”

Dr. Watkin and then pathology resident Ben Witt, MD, surveyed HPV ordering in the NorthShore system for the year 2009 to see how well clinicians were following the guidelines. Among 59,026 Pap tests ordered, 45,227 (83 percent) were ordered in women age 30 and older. While HPV testing was also ordered for 93 percent of these women, only in 39 percent was the order optimal—automatic testing for hrHPV genotypes. In 43 percent, hrHPV testing was ordered as a reflex for ASC-US cytology, and in 11 percent both high-risk and low-risk HPV genotypes were ordered.

Among women under age 21, only 11 percent of HPV tests were ordered appropriately—“no HPV.” The highest fraction of appropriate testing, 76 percent, was ordered in the 11,250 women age 21 to 29—“reflex if ASC-US.” Overall, HPV test ordering was optimal in only about 45 percent of the women having a Pap screen. Low-risk HPV testing was ordered in about 10 percent of women in all three age categories. “Should we even be offering low-risk HPV testing?” Dr. Watkin wonders.

Complete data from this study will be presented in February 2011 at the USCAP meeting.

—William Check, PhD


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