Risk of high-grade cervical intra-epithelial neoplasia based on cytology and high-risk HPV testing at baseline and at 6-months

Saskia Bulk, Nicole W.J. Bulkmans, Johannes Berkhof, Lawrence Rozendaal, A. Joan P. Boeke, Rene H.M. Verheijen, Peter J.F. Snijders, Chris J.L.M. Meijer

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Adding a test for high-risk human papillomavirus (hrHPV) to cytological screening enhances the detection of high-grade cervical intraepithelial neoplasia (≥CIN2), but data are required that enable long-term evaluation of screening. We investigated the ≥CIN2 risk for women participating in population-based screening as a function of hrHPV and cytology testing results at baseline and at 6 months. We included 2,193 women aged 30-60 years participating in a population-based screening trial who received colposcopy or a repeat testing advice at baseline. The main endpoint was histologically confirmed ≥CIN2 diagnosed within 36 months. hrHPV testing was more sensitive than cytology for ≥CIN2 (relative sensitivity 1.4, 95%CI: 1.3-1.5; absolute sensitivity 94.1 and 68.0%, respectively). The 18-month ≥CIN2 risks in women with a hrHPV-positive smear and in women with abnormal cytology were similar (relative risk 0.9, 95%CI: 0.8-1.1). Women with HPV16 and/or HPV18 had a higher ≥CIN2 risk than other hrHPV-positive women irrespective of the cytological grade. Repeat testing showed that both cytological regression and viral clearance were strongly associated with a decrease in ≥CIN2 risk. Notablv, women who had a double negative repeat test at 6 months had a ≥CIN2 risk of only 0.2% (95%CI: 0.0-1.1) and hrHPV-negative women with baseline borderline or mild dyskarvosis and normal cvtologv at 6 months had a ≥CIN2 risk of 0% (95%CI: 0.0-0.8). Using hrHPV and/or cytology testing, risk of ≥CIN2 can be assessed more accurately by repeat testing than single visit testing. Hence, when hrHPV testing is implemented, patient management with repeat testing is a promising strategy to control the number of referrals for colposcopy.

Original languageEnglish
Pages (from-to)361-367
Number of pages7
JournalInternational Journal of Cancer
Volume121
Issue number2
DOIs
Publication statusPublished - 15 Jul 2007

Cite this

@article{f4f34f1ed63f4b059f4977dd75d744d8,
title = "Risk of high-grade cervical intra-epithelial neoplasia based on cytology and high-risk HPV testing at baseline and at 6-months",
abstract = "Adding a test for high-risk human papillomavirus (hrHPV) to cytological screening enhances the detection of high-grade cervical intraepithelial neoplasia (≥CIN2), but data are required that enable long-term evaluation of screening. We investigated the ≥CIN2 risk for women participating in population-based screening as a function of hrHPV and cytology testing results at baseline and at 6 months. We included 2,193 women aged 30-60 years participating in a population-based screening trial who received colposcopy or a repeat testing advice at baseline. The main endpoint was histologically confirmed ≥CIN2 diagnosed within 36 months. hrHPV testing was more sensitive than cytology for ≥CIN2 (relative sensitivity 1.4, 95{\%}CI: 1.3-1.5; absolute sensitivity 94.1 and 68.0{\%}, respectively). The 18-month ≥CIN2 risks in women with a hrHPV-positive smear and in women with abnormal cytology were similar (relative risk 0.9, 95{\%}CI: 0.8-1.1). Women with HPV16 and/or HPV18 had a higher ≥CIN2 risk than other hrHPV-positive women irrespective of the cytological grade. Repeat testing showed that both cytological regression and viral clearance were strongly associated with a decrease in ≥CIN2 risk. Notablv, women who had a double negative repeat test at 6 months had a ≥CIN2 risk of only 0.2{\%} (95{\%}CI: 0.0-1.1) and hrHPV-negative women with baseline borderline or mild dyskarvosis and normal cvtologv at 6 months had a ≥CIN2 risk of 0{\%} (95{\%}CI: 0.0-0.8). Using hrHPV and/or cytology testing, risk of ≥CIN2 can be assessed more accurately by repeat testing than single visit testing. Hence, when hrHPV testing is implemented, patient management with repeat testing is a promising strategy to control the number of referrals for colposcopy.",
keywords = "Cervical cancer, Human papillomavirus, Screening, Sensitivity",
author = "Saskia Bulk and Bulkmans, {Nicole W.J.} and Johannes Berkhof and Lawrence Rozendaal and Boeke, {A. Joan P.} and Verheijen, {Rene H.M.} and Snijders, {Peter J.F.} and Meijer, {Chris J.L.M.}",
year = "2007",
month = "7",
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doi = "10.1002/ijc.22677",
language = "English",
volume = "121",
pages = "361--367",
journal = "International Journal of Cancer",
issn = "0020-7136",
publisher = "Wiley-Liss Inc.",
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Risk of high-grade cervical intra-epithelial neoplasia based on cytology and high-risk HPV testing at baseline and at 6-months. / Bulk, Saskia; Bulkmans, Nicole W.J.; Berkhof, Johannes; Rozendaal, Lawrence; Boeke, A. Joan P.; Verheijen, Rene H.M.; Snijders, Peter J.F.; Meijer, Chris J.L.M.

In: International Journal of Cancer, Vol. 121, No. 2, 15.07.2007, p. 361-367.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Risk of high-grade cervical intra-epithelial neoplasia based on cytology and high-risk HPV testing at baseline and at 6-months

AU - Bulk, Saskia

AU - Bulkmans, Nicole W.J.

AU - Berkhof, Johannes

AU - Rozendaal, Lawrence

AU - Boeke, A. Joan P.

AU - Verheijen, Rene H.M.

AU - Snijders, Peter J.F.

AU - Meijer, Chris J.L.M.

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AB - Adding a test for high-risk human papillomavirus (hrHPV) to cytological screening enhances the detection of high-grade cervical intraepithelial neoplasia (≥CIN2), but data are required that enable long-term evaluation of screening. We investigated the ≥CIN2 risk for women participating in population-based screening as a function of hrHPV and cytology testing results at baseline and at 6 months. We included 2,193 women aged 30-60 years participating in a population-based screening trial who received colposcopy or a repeat testing advice at baseline. The main endpoint was histologically confirmed ≥CIN2 diagnosed within 36 months. hrHPV testing was more sensitive than cytology for ≥CIN2 (relative sensitivity 1.4, 95%CI: 1.3-1.5; absolute sensitivity 94.1 and 68.0%, respectively). The 18-month ≥CIN2 risks in women with a hrHPV-positive smear and in women with abnormal cytology were similar (relative risk 0.9, 95%CI: 0.8-1.1). Women with HPV16 and/or HPV18 had a higher ≥CIN2 risk than other hrHPV-positive women irrespective of the cytological grade. Repeat testing showed that both cytological regression and viral clearance were strongly associated with a decrease in ≥CIN2 risk. Notablv, women who had a double negative repeat test at 6 months had a ≥CIN2 risk of only 0.2% (95%CI: 0.0-1.1) and hrHPV-negative women with baseline borderline or mild dyskarvosis and normal cvtologv at 6 months had a ≥CIN2 risk of 0% (95%CI: 0.0-0.8). Using hrHPV and/or cytology testing, risk of ≥CIN2 can be assessed more accurately by repeat testing than single visit testing. Hence, when hrHPV testing is implemented, patient management with repeat testing is a promising strategy to control the number of referrals for colposcopy.

KW - Cervical cancer

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