The unnecessary and improper use of HPV testing suggests that actions such as limiting test reimbursement and educating health care providers are needed to eliminate unnecessary low-risk testing, the researchers said.
"When it comes to low-risk HPV testing, the take-home message to clinicians is simple: Women should stop being tested for low-risk HPV," Ms. Lee said in an interview. "We already know that low-risk HPV types are nononcogenic, so testing for low-risk HPV is not useful in determining a woman’s risk for developing cervical cancer. We also want to make clear that although low-risk HPV types are associated with genital warts, having a positive low-risk HPV test does not mean a woman will develop genital warts, nor does it provide any prognosis for women who have genital warts," she said.
"By knowing this information, clinicians will hopefully feel empowered to request their laboratories to provide high-risk-HPV-only testing, instead of a combined low- and high-risk HPV test," she added.
More work is needed to improve the clinical value of HPV testing, the researchers said. "Eliminating the low-risk HPV test and making the high-risk HPV test the only option would help minimize confusion for providers when ordering the HPV test. Removing incentives for this practice like insurance reimbursement is another method that may be effective," Ms. Lee said.
"Interventions that can help providers use HPV tests appropriately include changing laboratory requisition forms to reflect guideline-consistent HPV testing and point-of-care decision support algorithms that are designed to give patient-specific recommendations," she said.
In an accompanying editorial, Philip E. Castle, Ph.D., of the American Society for Clinical Pathology in Chicago, noted that the overuse and improper use of HPV testing has negative effects on patients: "A patient who tests HPV positive has a wide range of negative psychosocial and psychosexual outcomes, including anxiety, distress, and a decreased sense of sexual well-being."
He also emphasized the impact of unnecessary HPV testing on the health care system: "With an estimated $4 billion spent on cervical cancer prevention alone in 2004, we can no longer afford to perform tests that do not benefit our patients" (Obstet. Gynecol. 2011;118:1-3).
Dr. Castle supported the study authors’ call for better education of clinicians, for they have the final responsibility for the use of HPV testing. He said it also would be helpful if payers stopped reimbursing for these unnecessary HPV tests, for that would quickly put a halt to such practices. He emphasized, "Overuse of HPV testing not only seriously wastes government, payer, and patient dollars, but also potentially harms patients, therefore violating the first tenet of the Hippocratic Oath: Do no harm."
Neither the study authors nor Dr. Castle said they had any relevant financial disclosures.