HealthDay News —  In family medicine clinics testing for human papillomavirus (HPV) varies substantially by provider sex, provider type and across clinics, study results indicate.

Overall, annual cytology requests increased 46% between 2008 and 2011, with female providers being twice as likely to order HPV testing for any cytology result compared with male providers (P<0.001), Marisyl D. de la Cruz, MD, from the University of Michigan in Ann Arbor, and colleagues reported in the Journal of the American Board of Family Medicine.

Residents/fellows were significantly more likely to order HPV testing for all results than faculty and NP/PAs (P<0.001). In contrast, the NP/PAs were significantly more likely to order HPV testing for atypical squamous cells of undetermined significance (ASCUS) only compared with faculty and residents/fellows (P<0.001).

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“The results of this study are important because they indicate that clinic differences based on training can lead to variations in ordering practices for HPV testing and possibly inappropriate ordering of HPV testing,” the researchers wrote.

Current recommendations state HPV DNA cotesting be performed with normal cytology results only when extending the interval of cytology from three to five years or to triage women with ASCUS.

To examine trends in HPV cotesting testing for normal cervical cytology results among low-risk women aged 30 to 65 years, the researchers  analyzed completed HPV orders from clinicians who performed Papanicolaou smears at five Michigan family medicine clinics from January 2008 to April 2011.

Cytology request forms from 55 faculty, 37 residents/fellows and five NP/PAs were audited. A total of 833 cytology request forms for low-risk women were included in the analysis.

Overall, 622 family medicine faculty requested cytology (75%), followed by 169 residents/fellows (20%) and 42 nurse practitioners and physician assistants (5%), the researchers found.

HPV was ordered for “all results” on 324 request forms (39%), the researchers found, with 48%, 38% and 10% ordered by residents/fellows, faculty and NP/PAs, respectively.

“As HPV testing becomes more frequent, there should be an emphasis on improving the current options to order HPV tests,” the researchers wrote. “Additional interventions should focus on best practices to facilitate appropriate HPV testing to improve cervical cancer screening and long-term outcomes for women.”


  1. de la Cruz MSD et al. Am Board Fam Med. 2013;26(6): 720-727.