Statement on human papillomavirus DNA test utilization.

In 2009, the Cytopathology Education and Technology Consortium issued a statement on human papillomavirus (HPV) DNA test utilization that was published in multiple journals. 1 This statement was a concise summary of the clinical indications for high-risk or oncogenic HPV testing based on guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP) and the American Cancer Society (ACS) published from 2002 through 2007. 2,3 These organizations have since published newer consensus guidelines addressing HPV testing, 4,5 and the previous summary no longer reflects current screening and management guidelines. High-risk HPV testing has proven utility in both cervical cancer screening and management. The 2012 screening guidelines endorsed by the ACS, ASCCP, and the American Society for Clinical Pathology state that combined cervical cytology and HPV testing is now the preferred strategy for women 30 years and older. The 2012 ASCCP guidelines for the management of abnormal cervical cancer screening tests and cancer precursors utilize cotesting extensively as both a sensitive and efficient way to manage and follow these women. Inappropriate or too-frequent screening, including HPV testing, can lead to increased costs without proven benefit and may also cause patient harm by overtreatment. The educational statement below is intended to improve adherence to current guidelines, thereby improving the health care of women. The American College of Obstetricians and Gynecologists affirms these recommendations and the US Preventive Services Task Force states that cotesting is acceptable ❚Figure 1❚. 6,7 1. High-risk (oncogenic) HPV DNA testing is appropriate in the following circumstances: 1.1. Routine cervical cancer screening in conjunction with cervical cytology (cotesting) for women aged 30 to 65 years (for women aged 30-65 years with cytology reported as absent or insufficient endocervical/transformation zone component, early repeat cytology is not indicated and cotesting is preferred). 1.1.1. For women whose cytology and HPV results are both negative, repeat both tests only after a 5-year interval (applies only to routine screening; for women with negative cotests after previous abnormal cytology, see below). 1.1.2. For women whose cytology results are negative and whose HPV test is positive, repeat both tests within 1 year or perform HPV type 16/18 (HPV16/18) genotyping; women with HPV16/18-positive results are referred for colposcopy. 1.2. Initial triage management of women 25 years or older with a cytology result of typical squamous cells of undetermined significance (ASC-US). Triage management is acceptable for women aged 21 to 24 years, but repeat cytology at 12 …