Routine Screening for Human Papillomavirus DNA Questioned

Experts believe that testing women for human papillomavirus (HPV) by molecular methods is being ordered too often and sometimes unnecessarily.

Many female patients are tested for HPV DNA, which is inconsistent with the guidelines, and not only leads to unnecessary expenses, but also the extra treatment sometimes assigned by doctors that can lead to added unnecessary complications and side effects.

Scientists at the US Centers for Disease Control and Prevention, (CDC, Atlanta, GA, USA), analyzed the self-reported human papillomavirus (HPV) DNA testing practices by health care providers and clinics. The study included nonrecommended practices such as low-risk HPV testing, HPV co-testing in women younger than age 30 years, and HPV reflex testing for high-grade abnormal Papanicolaou (Pap) test results. Data analysis was performed on responses from 376 office-based health care providers and 216 outpatient clinics.

Overall, 75.5% of health care providers and 77.2% of clinics reported ever using the HPV DNA test. Of health care providers who used HPV testing, 28.5% used both high-risk and low-risk HPV tests. About 60% of health care providers and 66.0% of clinics used HPV co-testing in women younger than age 30 years. A high percentage of health care providers and clinics performed reflex HPV testing after Pap test results of atypical squamous cells, and high-grade squamous intraepithelial lesions results for which HPV testing is not recommended.

The authors concluded that many health care providers reported inappropriate uses of HPV testing, which may lead to unnecessary follow-up and increased medical costs without added benefits. Interventions such as eliminating the low-risk HPV test from the US market and educating health care providers and patients on appropriate indications for HPV testing are needed to discourage health care providers from such practices.

Philip Castle, PhD, MPH, from the American Society for Clinical Pathology, (Chicago, IL, USA), said: "There's a much greater emphasis on avoiding a single cancer versus literally thousands of women being over-screened and over-treated. The low-risk test really has no business being on the market at all. There's a lot of HPV and very little disease in women in their 20s. The disease that's found there is generally about 10 to 15 years away from becoming invasive. There's no good justification for using the HPV test routine."

There is currently no specific treatment for HPV infection. However, the viral infection, more often than not, clears by itself, as the body's immune system clears HPV naturally within two years for 90% of cases. However, experts do not agree on whether the virus is completely eliminated or reduced to undetectable levels, and it is difficult to know when it is contagious. The study was published in July 2011, in Obstetrics & Gynecology.

Related Links:
US Centers for Disease Control and Prevention
American Society for Clinical Pathology