Risk of cervical intraepithelial neoplasia grade 3 or worse in HPV-positive women with normal cytology and five-year type concordance: a randomized comparison

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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 grade 3 or worse (CIN3+) after repeatedly testing positive for the same HPV type(s) in the randomized population-based screening study Amsterdam (POBASCAM). We compared 18-month CIN3+ risks in HPV-positive women (intervention, n=1 066) to those in HPV-positive/cytology-negative women who tested HPV-positive in the next screening round (control, n=111) five years later, stratified for HPV type concordance.

RESULTS: The 18-month CIN3+ 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 CIN3+ 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 CIN3+ 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.

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