Abstract C73: Prevalence of HPV DNA testing among a diverse sample of uninsured and underinsured women in New Jersey
Authors: Llanos Adana A.M. , Tsui Jennifer , Rotter David , Toler Lindsey , Africa Candido A. , Stroup Antoinette M. 
Published: March 2017

Introduction: Beginning in 2004, high-risk human papillomavirus (HPV) testing using the Hybrid Capture 2 gene test was approved for use concurrently with cytology (co-testing) as a primary cervical cancer screening test for women age ≥30 years. However, little population-based data exist on the utilization of HPV testing in the United States, particularly for underserved women with higher risk of developing cervical cancer. The objective of this study was to examine the prevalence of HPV testing among a diverse sample of uninsured and underinsured women using data from the New Jersey Cancer Early Education and Detection (NJCEED) Program.

Methods: De-identified data were obtained from NJCEED for women screened at least once for cervical cancer through the program between 2002 and 2015. Descriptive statistics (means and standard deviations [SD]) were used to examine prevalence of HPV testing. T-tests and Chi square tests were used to examine differences in participant characteristics (age, race/ethnicity, country of origin) by HPV test status (had HPV DNA test vs. did not have HPV DNA test) during the study period.

Results: From 2002 to 2015, 16,428 (14.1%) of the 116,313 women (mean age 46 years) enrolled in NJCEED had a HPV DNA test. Most of the participants were ≥30 years (88.2%) and of minority race/ethnicity (72.9%). Utilization of HPV DNA testing differed significantly (all P-values &lt;0.0001) by participants' age at first NJCEED visit, race/ethnicity, country of origin, total number of cervical cancer screening visits, and total number of different tests done per screening visit. While less than 15% of study participants had an HPV DNA test, testing among women age ≥30 years was much more similar to the overall rate than among women &lt;30 years (14.8% vs. 9.3%). Prevalence of HPV DNA testing was higher among non-Hispanic Blacks (17.7%) and Asian/Pacific Islanders (21.8%) than Hispanics (11.6%), although Hispanics represented approximately 50% of the study sample. Women who were born in Asian and Middle Eastern countries (26.2%), the United States (19.2%), and the Caribbean (15.0%) had higher prevalence of HPV DNA testing than those from Central and South America (9.8%), Africa (8.7%), Europe, Australia and Oceania (7.6%), and other countries outside the U.S. (3.5%). The mean number of cervical cancer screening visits was higher among those who had a HPV DNA test than those who did not (2.4±2.3 vs. 1.8±1.6) as was the mean number of tests (e.g., Pap tests, pelvic exams) done per screening visit (2.8±0.6 vs. 2.1±0.5).

Conclusions: These findings from a large population-based study in New Jersey show than less than 15% of uninsured and underinsured women had a HPV DNA test done between 2002 and 2015 and that there are differences in the utilization of HPV DNA testing by sociodemographic characteristics. Further analysis will explore significant determinants of utilization of HPV DNA testing and prevalence of high-risk HPV positivity in this population. As cervical cancer continues to disproportionately burden economically disadvantaged groups and racial/ethnic minorities, it is essential that we increase our understanding of the causes of low cervical cancer screening rates among groups that may benefit most from screening and ultimately develop interventions for addressing this important issue.

Citation Format: Adana A.M. Llanos, Jennifer Tsui, David Rotter, Lindsey Toler, Candido A. Africa III, Antoinette M. Stroup. Prevalence of HPV DNA testing among a diverse sample of uninsured and underinsured women in New Jersey. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C73.