TY - JOUR
T1 - Risk of Cervical Intraepithelial Neoplasia Grade 3 or Worse in HPV-Positive Women with Normal Cytology and Five-Year Type Concordance: A Randomized Comparison
AU - Inturrisi, Federica
AU - Bogaards, Johannes A.
AU - Heideman, Danielle A. M.
AU - Meijer, Chris J. L. M.
AU - Berkhof, Johannes
N1 - Publisher Copyright:
© 2020 American Association for Cancer Research.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/3
Y1 - 2021/3
N2 - Background: In human papillomavirus (HPV)-based cervical screening programs, management of HPV-positive women with normal cytology is debated. Longitudinal information on HPV type persistence may be employed for risk stratification. Methods: We assessed the risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3þ) after repeatedly testing positive for the same HPV type(s) in the randomized population-based screening study Amsterdam (POBASCAM). We compared 18-month CIN3þ risks in HPV-positive women (intervention, n ¼ 1,066) to those in HPV-positive/cytology-negative women who tested HPV-positive in the next screening round (control, n ¼ 111) five years later, stratified for HPV type concordance. Results: The 18-month CIN3þ risk was 15% in HPV-positive women in the intervention group, 40% in the control group after two-round type concordance (relative risk 2.6, 95% confidence interval 1.9–3.4), and 20% in the control group after a type switch (1.3, 0.5–3.2). The relative increase in CIN3þ risk after two-round type concordance was similar in <35-year-old (3.0, 2.0–4.4) and older women (2.2, 1.4–3.5), and was high in high-risk HPV-positive women who were HPV16/18/31/33/45-negative in both rounds (9.9, 4.4–21.9). Conclusions: Five-year HPV type concordance signals high CIN3þ risk and warrants referral for colposcopy without additional cytology triage. Impact: HPV screening programs become highly efficient when HPV-positive women with negative triage testing at baseline are offered repeat HPV genotyping after five years.
AB - Background: In human papillomavirus (HPV)-based cervical screening programs, management of HPV-positive women with normal cytology is debated. Longitudinal information on HPV type persistence may be employed for risk stratification. Methods: We assessed the risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3þ) after repeatedly testing positive for the same HPV type(s) in the randomized population-based screening study Amsterdam (POBASCAM). We compared 18-month CIN3þ risks in HPV-positive women (intervention, n ¼ 1,066) to those in HPV-positive/cytology-negative women who tested HPV-positive in the next screening round (control, n ¼ 111) five years later, stratified for HPV type concordance. Results: The 18-month CIN3þ risk was 15% in HPV-positive women in the intervention group, 40% in the control group after two-round type concordance (relative risk 2.6, 95% confidence interval 1.9–3.4), and 20% in the control group after a type switch (1.3, 0.5–3.2). The relative increase in CIN3þ risk after two-round type concordance was similar in <35-year-old (3.0, 2.0–4.4) and older women (2.2, 1.4–3.5), and was high in high-risk HPV-positive women who were HPV16/18/31/33/45-negative in both rounds (9.9, 4.4–21.9). Conclusions: Five-year HPV type concordance signals high CIN3þ risk and warrants referral for colposcopy without additional cytology triage. Impact: HPV screening programs become highly efficient when HPV-positive women with negative triage testing at baseline are offered repeat HPV genotyping after five years.
UR - http://www.scopus.com/inward/record.url?scp=85102112139&partnerID=8YFLogxK
U2 - 10.1158/1055-9965.EPI-20-1336
DO - 10.1158/1055-9965.EPI-20-1336
M3 - Article
C2 - 33293342
VL - 30
SP - 485
EP - 491
JO - Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
JF - Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
SN - 1055-9965
IS - 3
ER -