Lab Report: Who should be tested for HPV?

Reprinted from the Lane County Medical Society newsletter “Of Interest.” Readers are invited to submit test-related questions by e-mailing[email protected].

Q: The HPV vaccine is getting lots of attention, but what are the current guidelines for HPV testing?

A: With high risk HPV clearly recognized as the cause of most cervical cancer, the HPV DNA test is used for both diagnostic and screening purposes.

For all women, the HPV test is used to help clarify an ASCUS (Atypical Squamous Cells of Undetermined Significance) diagnosis. In these cases, it is recommended that an HPV test be run on the liquid-based (LB) specimen to discover if the HPV virus is indeed the culprit for the atypical cells. Ordering “HPV DNA reflex” allows for LBC specimens with an ASCUS diagnosis to automatically be tested for HPV. With a diagnosis more severe than ASCUS, HPV testing would be done at the physician’s discretion.

It’s important to note that HPV testing cannot be performed on conventional Pap smears, only on LB Paps. LB Paps, which are almost 30% more sensitive at revealing HGSIL than conventional paps, also allow for HPV testing to be ordered for specimens already in the lab. This avoids the need to call the patient back for recollection and may expedite treatment.

HPV DNA testing is not recommended in patients previously diagnosed with LGSIL, ASCUS-H (atypical squamous cells cannot exclude HGSIL), HGSIL or atypical glandular lesions. These patients should undergo immediate colposcopy.

Age 30 and older

ACOG, ACS and ASCCP recommend all women age 30 and older be screened for HPV, as persistent HPV infections are seen most often in this population. At younger ages, the prevalence of HPV is high, whereas the progression to cervical cancer in these patients is relatively low. The decreasing prevalence of HPV in women older than 30, and the improved specificity of HPV testing in predicting CIN 2 and CIN 3, makes the combination of Pap plus HPV a practical screening test for women in this age group.

Studies using combined HPV testing with cervical cytology for this age group have reported a negative predictive value for CIN 2 and CIN 3 of 99-100%.

Added risk factors

HPV screening is even more important for women age 30 and older with the following risk factors:

• History of a prior abnormal pap
• History of cervical cancer
• Compromised immune system
• Current smoker
• History of DES exposure
• Women who were not well screened in their 20s

Vaccine does not supersede HPV testing

Initial guidelines indicate girls age 11-26 receive the HPV vaccine before onset of sexual activity. With the HPV test recommended for a very different population, the HPV test is expected to be relevant for decades.