Type-specific HPV and Pap test results among low-income, underserved women: Providing insights into management strategies

Mona Saraiya, Vicki B. Benard, April A. Greek, Martin Steinau, Sonya Patel, L. Stewart Massad, George F. Sawaya, Elizabeth R. Unger

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Results Pap test results were abnormal in 6.0% and HPV was positive in 7.2% of the underserved women screened in this study (mean age, 45.1 years). HPV prevalence decreased with age, from 10.3% among 30- to 39-year-olds to 4.5% among 50- to 60-year-olds. About 5% of the women had a combination of a positive HPV test and normal Pap test results; HPV 16/18 was identified in 14% of discordant women.

Objective The primary cervical cancer screening strategy for women over age 30 is high-risk human papillomavirus (HPV) testing combined with Papanicolaou (Pap) testing (cotesting) every 5 years. This combination strategy is a preventive service that is required by the Affordable Care Act to be covered with no cost-sharing by most health insurance plans. The cotesting recommendation was made based entirely on prospective data from an insured population that may have a lower proportion of women with HPV positive and Pap negative results (ie, discordant results). The discordant group represents a very difficult group to manage. If the frequency of discordant results among underserved women is higher, health care providers may perceive the cotesting strategy to be a less favorable screening strategy than traditional Pap testing every 3 years. Study Design The Centers for Disease Control and Prevention's Cervical Cancer Study was conducted at 15 clinics in 6 federally qualified health centers across Illinois. Providers at these clinics were given the option of cotesting for routine cervical cancer screening. Type-specific HPV detection was performed on residual extracts using linear array.

Conclusion The rate of discordant results among underserved women was similar to those reported throughout the US in a variety of populations. Typing for HPV 16/18 appears to assist in the management in a small proportion of women with discordant results.

Original languageEnglish
Pages (from-to)354.e1-354.e6
JournalAmerican journal of obstetrics and gynecology
Issue number4
StatePublished - Oct 1 2014


  • HPV testing
  • Pap test
  • cotesting
  • genotying
  • underserved Populations


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