199224 Utilizing laboratory informatics to assess trends of cervical cancer screening in an east coast heath system, 2001-2007

Monday, November 9, 2009: 12:50 PM

Darcy F. Phelan, MHS, DrPH , Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD
John K. Boitnott, MD , Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
Douglas P. Clark, MD , Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
Lisa C. Dubay, PhD, ScM , Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Patti E. Gravitt, MS, PhD , Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD
  
Background: The Pathology Data System (PDS) contains laboratory specimen record information, test results, and diagnoses. The HPV test is FDA approved for two indications in cervical cancer screening: (1) reflex testing of ASC-US (atypical squamous cells of undetermined significance) Pap results and (2) co-testing with Pap among women ≥ 30 years. Methods: We utilized 178,510 Pap specimen records and 12,221 HPV tests among 85,048 patients to examine testing from January 2001 to December 2007. Monthly frequencies and proportions of HPV reflex testing and HPV co-testing with Pap (stratified by patient ages ≥ 30 and 18-29 years) were calculated. Time trends of HPV testing were analyzed using joinpoint regression methods. Results: Liquid-based Pap testing increased from 769 to 1,866 tests per month, while conventional testing decreased from 1,931 to 0 tests per month. The monthly proportion of HPV reflex testing grew from 80.4% to 95.8%. The overall proportion of HPV co-testing with Pap among patients ≥ 30 years was 7.8% (versus 4.9% among patients 18-29 years (p<0.01)). Time trend analyses revealed that the monthly proportions of HPV reflex testing and co-testing with Pap changed significantly over time. Conclusions: Utilizing laboratory informatics allowed us to document trends in cervical cancer screening. The monthly proportion of HPV reflex testing increased to nearly 100% while the proportion of HPV co-testing with Pap among patients ≥ 30 years was low and plateaued around 13%. These data reveal that, despite screening guidelines, a small percentage of women ≥ 30 years received HPV co-testing with Pap.

Learning Objectives:
1. List the two FDA approved uses of the HPV test in cervical cancer screening. 2. Name three practical components of an informatics-based data source. 3. Describe two different methods for analyzing time trend data.

Keywords: Cancer Screening, Women's Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I hold a Master of Health Science (MHS) in Epidemiology from the Johns Hopkins School of Public Health. I conducted this research as part of my Doctor of Public Health (DrPH) dissertation in Epidemiology at Johns Hopkins. I was an invited speaker at the Maryland Department of Health and Mental Hygiene for its Cancer Data Speaker Series. I've presented this work to the Baltimore City Health Department and the Johns Hopkins Medical Institutions Department of Pathology. The value of this work was also recognized when my dissertation research was funded with a R36 Dissertation Award from the CDC. The paper of my Masters research on HPV (i.e., the cause of cervical cancer) will be published in 'Sexually Transmitted Diseases' in March 2009.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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