652 Obstetrics and Gynecology Board Review •••
❍ What are the most common HPV types that lead to cervical carcinoma?
HPV 16, 18.
❍ How is High Risk HPV testing used in screening tests?
An adjunct to cytology in women 30 to 65 years old and in ASCUS pap reflex testing to determine the need for
colposcopy.
❍ What is co-testing?
Cytology plus HPV testing.
❍ Which genotypes are tested in reflex HPV testing?
16, 18.
❍ What is the time from HPV infection to cervical cancer?
A median of 15 to 25 years.
❍ Why were the screening guidelines changed from screening every 3 to 5 years?
There was a negligible difference in the risk of cancer with increase in colposcopic procedures.
❍ Why is co-testing for women aged 21 to 29 not recommended?
In this population, HPV testing usually detects transient infection without carcinogenic potential.
❍ How often should you screen for cervical cancer?
Screening is age dependent.
21 to 29 years old cytology alone every 3 years.
30 to 65 years old cytology alone every 3 years or co-testing every 5 years.
Over 65 years old, no screening if negative adequate test results. If the patient has a history of CIN 2-3 or
adenocarcinoma, then continue screening for 20 years.
❍ What is an adequate negative test result?
Defined as three negative, consecutive cytology results or two consecutive co-test results in 10 years with the last
one being in the past 5 years.
❍ Which is the preferred method of screening in the age of 30 to 65?
Co-testing is preferred because it is more sensitive in detection of CIN 3 and adenocarcinoma.
❍ How do you manage a positive HPV test and negative cytology in women over 30 years old?
(1) Repeat HPV testing in 1 year and if repeat test is positive perform colposcopy or
(2) Reflex to HPV genotype and if positive for HP 16, 18 perform colposcopy, if negative repeat co-testing testing
in 12 months.