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Showing content from https://pubmed.ncbi.nlm.nih.gov/21684207/ below:

Cervical cancer risk for women undergoing concurrent testing for human papillomavirus and cervical cytology: a population-based study in routine clinical practice

Affiliations

• ¹ Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD 20882, USA. katkih@mail.nih.gov

• PMID: 21684207
• PMCID: PMC3272857
• DOI: 10.1016/S1470-2045(11)70145-0

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Hormuzd A Katki et al. Lancet Oncol. 2011 Jul.

• ¹ Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD 20882, USA. katkih@mail.nih.gov

• PMID: 21684207
• PMCID: PMC3272857
• DOI: 10.1016/S1470-2045(11)70145-0

Item in Clipboard

• Lancet Oncol. 2011 Aug;12(8):722

Background: Concurrent testing for human papillomavirus (HPV) and cervical cytology (co-testing) is an approved alternative to cytology alone in women aged 30 years and older. We aimed to assess the safety in routine clinical practice of 3-year screening intervals for women testing negative for HPV with normal cytology and to assess if co-testing can identify women at high risk of cervical cancer or cervical intraepithelial neoplasia grade 3 (CIN3) or worse over 5 years.

Methods: We assessed the 5-year cumulative incidence, starting in 2003-05, of cervical cancer and CIN3 or worse for 331,818 women aged 30 years and older who enrolled in co-testing at Kaiser Permanente Northern California (Berkeley, CA, USA) and had adequate enrolment co-test results. Follow-up continued until Dec 31, 2009. We defined cumulative incidence to include prevalence at enrolment and incidence after enrolment. Prevalence at enrolment was defined as the ratio of women diagnosed with each outcome on the biopsy visit immediately after their enrolment screening visit to the total enrolled women. At screening visits only HPV test and Pap smear samples were collected, and at biopsy visits colposcopically directed biopsies were taken. To estimate post-enrolment incidence, we used Weibull survival models.

Findings: In 315,061 women negative by HPV testing, the 5-year cumulative incidence of cancer was 3.8 per 100,000 women per year, slightly higher than for the 306,969 who were both negative by HPV and Pap testing (3.2 per 100,000), and half the cancer risk of the 319,177 who were negative by Pap testing (7.5 per 100,000). 313,465 (99.5%) women negative by HPV testing had either normal cytology or equivocal abnormalities. Abnormal cytology greatly increased cumulative incidence of CIN3 or worse over 5 years for the 16,757 positive by HPV testing (12.1%vs 5.9%; p<0.0001). By contrast, although statistically significant, abnormal cytology did not increase 5-year risk of CIN3 or worse for women negative by HPV testing to a substantial level (0.86%vs 0.16%; p=0.004). 12,208 (73%) of the women positive by HPV testing had no cytological abnormality, and these women had 258 (35%) of 747 CIN3 or adenocarcinoma in situ, [corrected] 25 (29%) of 87 cancers, and 17 (63%) of 27 adenocarcinomas.

Interpretation: For women aged 30 years and older in routine clinical practice who are negative by co-testing (both HPV and cytology), 3-year screening intervals were safe because a single negative test for HPV was sufficient to reassure against cervical cancer over 5 years. Incorporating HPV testing with cytology also resulted in earlier identification of women at high risk of cervical cancer, especially adenocarcinoma. Testing for HPV without adjunctive cytology might be sufficiently sensitive for primary screening for cervical cancer.

Funding: Intramural Research Program of the US National Cancer Institute/NIH/DHHS, and the American Cancer Society.

Copyright © 2011 Elsevier Ltd. All rights reserved.

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NOTE: Data are shown on cumulative incidence of CIN3+ by enrollment HPV test versus Pap smear. “Pap−“ means Pap-negative (NILM). “Pap+” means any abnormality (non-NILM). In Panel A, HPV test results are in blue, Pap smear test results are in black, positive test results are solid lines, and negative test results are dashed lines. Prevalent CIN3+ is plotted at time 0 (enrollment) and incident CIN3+ is plotted from that point. The HPV test more clearly separated high-risk women from low-risk women than the Pap smear because both (1) HPV+ women at enrollment had higher CIN3+ risk than the Pap+ women after 3 years (5.0% vs. 3.8%, p=0.046) and 5-years (7.6% vs. 4.7%, p=0.001), and (2) HPV− women at enrollment had lower CIN3+ risk than Pap− women at enrollment after 3-years (0.063% vs. 0.17%, p=0.001) and after 5-years (0.17% vs. 0.36%, p=0.02). In Panel B, HPV+ is in blue, HPV− is in black, Pap+ is solid and Pap− is dashed. Pap+ strongly modified risks for the HPV+ at three-years (10.0% vs. 3.1%, p<0.001) and five-years (12.1% vs. 5.9%, p<0.001), but not for the HPV− either at three-years (0.52% vs. 0.047%, p<0.001) or five-years (0.86% vs. 0.16%, p<0.001), although risks are statistically distinguishable. Comparing to Panel A, also being Pap-did not reduce CIN3+ risk from just being HPV− either at three-years (0.047% vs. 0.063%, p=0.6) or five-years (0.16% vs. 0.17%, p=0.8). See supplemental table 1 for 95% confidence intervals for all risk estimates. The number of women in each group are: HPV-positive: 16,757; HPV-negative: 315,061; Pap-positive: 12,641; Pap-negative: 319,177; HPV-positive/Pap-positive: 4,549; HPV-positive/Pap-negative: 12,208; HPV-negative/Pap-positive: 8,092; HPV-negative/Pap-negative: 306,969.

NOTE: Prevalent disease is plotted at time 0 (enrollment) and incident disease is plotted from that point. Although only 0.25% of women, women with ASC-H/HSIL/SCC Pap smears had by far the highest 3-year risks of CIN2+ (59%), CIN3+ (28%), and cancer (4.1%). Versus women with LSIL, women with HPV+/ASC-US had higher 3-year risk of CIN2+ (21% vs. 14%, p=0.01) and CIN3+ (6.4% vs. 3.2%, p=0.03). The majority (73%) of enrollment HPV+ women were HPV+/Pap−, and although they had by far the lowest disease risks at enrollment of any HPV+ group (CIN2+: 0.36%, CIN3+: 0.16%, Cancer: 0.04%), they accrued 5-year risks post-enrollment (CIN2+: 13%, CIN3+: 5.9%, Cancer: 0.5%) akin to women with ASC-H/HSIL/SCC (CIN2+: 14%, CIN3+: 6.1%, Cancer: 1.7%) or with HPV+/ASC-US (CIN2+: 13%, CIN3+: 4.5%, Cancer: 0%) (p=0.8 vs. ASC-H/HSIL/SCC, p=0.7 vs. HPV+/ASC-US). HPV+/Pap− women had higher 5-year cancer risk than HPV−/Pap+ women (0.54% vs. 0.16%, p=0.2). HPV−/ASC-US and HPV−/Pap− women had the smallest, and nearly indistinguishable, 5-year risks of CIN2+ (1.3% vs. 0.54%, p=0.07) and CIN3+ (0.54% vs. 0.16%, p=0.08). The 5-year cervical cancer risk in the enrollment HPV−/Pap− was 0.016% (3.2 per 100,000 women per year), only slightly smaller than the 0.019% (3.8/100,000/year) risk in the enrollment HPV− overall (p=0.8). By comparison, the 5-year cervical cancer risk in the Pap− was 0.037% (7.5/100,000/year) (p=0.3 vs. HPV− cancer risk). On the per 100,000 women per year scale, the 5-year cancer risks are: HPV−/Pap−: 3.2; HPV−/Pap+: 32; HPV+/Pap−: 108; HPV+/Pap+: 180. See supplemental table 1 for 95% confidence intervals for all risk estimates. The number of women in each group are: ASC-H/HSIL/SCC: 833; HPV+/ASC-US: 2,021; AGUS/NOS: 764; HPV-positive/Pap-negative: 12,208; LSIL: 2,527; HPV-negative/ASC-US: 6,496; HPV-negative/Pap-negative: 306,969.

NOTE: Data are shown on cumulative incidence of CIN3+ based on HPV test and Pap smear at the second screen, among women HPV−/Pap− at enrollment, for HPV test and Pap smear separately (Panel A), and jointly (Panel B). “Pap−“ means Pap-negative (NILM). “Pap+” means any abnormality (non-NILM). Prevalent CIN3+ is plotted at time 0 (second visit) and incident CIN3+ is plotted from that point. The y-axis goes to 12%, the maximum risk observed based on enrollment co-tests (Figure 1), to emphasize that CIN3+ risks for women HPV+ or Pap+ after enrollment HPV−/Pap− are markedly decreased from women HPV+ or Pap+ at enrollment. In Panel A, (1) women HPV+ at their return visit had higher 3-year CIN3+ risk than women Pap+ at their return visit (3.0% vs. 1.3%, p=0.2) and (2) women HPV− at their return visit had half the 3-year CIN3+ risk of women Pap− at their return visit (0.082% vs. 0.15%, p=0.3). Neither is statistically significant since there were only 102 CIN3+ at or after the second screening visit among women HPV−/Pap− at enrollment. However, comparing to enrollment co-test CIN3+ risks in Figure 1, the CIN3+ risks for women HPV+ or Pap+ have decreased markedly. In particular, the second HPV test (or Pap smear) does not separate 3-year CIN3+ risks as clearly as at enrollment (HPV+: 5.0% vs. 3.0%, p= 0.09; Pap+: 3.8% vs. 1.3%, p=0.04). Furthermore, comparing to Figure 1, the second HPV− test did not reduce 3-year CIN3+ risk accrued by the first HPV− result (0.082% vs. 0.063%, p=0.6); similarly, the second Pap− did not reduce the 3-year CIN3+ risk accrued by the first Pap− result (0.15% vs. 0.17%, p=0.8). In Panel B, being Pap+ modified risks more for the HPV+ (5.1% vs. 1.8%, p=0.4) than for the HPV− (0.19% vs. 0.079%, p=0.4), although neither is statistically significant. Comparing to figure 2, the 3-year risks were greater for HPV+/Pap+, HPV+/Pap−, HPV−/Pap+ at enrollment than at the second co-test (10.0% vs 5.1%, p=0.3; 3.1% vs. 1.8%, p=0.3; 0.52% vs. 0.19%, p=0.4), although none were statistically significant. However, comparing to Figure 2, risks were similar for HPV−/Pap− women at enrollment vs. women HPV−/Pap− again at their return visit (0.047% vs. 0.079%, p=0.5). Finally, being Pap− did not reduce 3-year CIN3+ risk from just being HPV− at second co-test after enrollment HPV−/Pap− (0.079% vs. 0.082%, p=0.9). See supplemental table 3 for 95% confidence intervals for all risk estimates. The number of women in each group are: HPV-positive: 5,381; HPV-negative: 190,594; Pap-positive: 8,453; Pap− negative: 187,522; HPV-positive/Pap-positive: 2,056; HPV-positive/Pap-negative: 3,325; HPV-negative/Pap-positive: 6,397; HPV-negative/Pap-negative: 184,197.

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  Rao J, Levin M, Zhao C. Rao J, et al. Lancet Oncol. 2011 Oct;12(11):992-3; author reply 993. doi: 10.1016/S1470-2045(11)70192-9. Lancet Oncol. 2011. PMID: 21968223 No abstract available.

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  Castle PE, Stoler MH, Wright TC Jr, Sharma A, Wright TL, Behrens CM. Castle PE, et al. Lancet Oncol. 2011 Sep;12(9):880-90. doi: 10.1016/S1470-2045(11)70188-7. Epub 2011 Aug 22. Lancet Oncol. 2011. PMID: 21865084 Clinical Trial.

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  C Kitchener H, Canfell K, Gilham C, Sargent A, Roberts C, Desai M, Peto J. C Kitchener H, et al. Health Technol Assess. 2014 Apr;18(23):1-196. doi: 10.3310/hta18230. Health Technol Assess. 2014. PMID: 24762804 Free PMC article. Clinical Trial.

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  Gilham C, Sargent A, Kitchener HC, Peto J. Gilham C, et al. Health Technol Assess. 2019 Jun;23(28):1-44. doi: 10.3310/hta23280. Health Technol Assess. 2019. PMID: 31219027 Free PMC article. Clinical Trial.

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  Cuzick J, Arbyn M, Sankaranarayanan R, Tsu V, Ronco G, Mayrand MH, Dillner J, Meijer CJ. Cuzick J, et al. Vaccine. 2008 Aug 19;26 Suppl 10:K29-41. doi: 10.1016/j.vaccine.2008.06.019. Vaccine. 2008. PMID: 18847555 Review.

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  Arbyn M, Ronco G, Anttila A, Meijer CJ, Poljak M, Ogilvie G, Koliopoulos G, Naucler P, Sankaranarayanan R, Peto J. Arbyn M, et al. Vaccine. 2012 Nov 20;30 Suppl 5:F88-99. doi: 10.1016/j.vaccine.2012.06.095. Vaccine. 2012. PMID: 23199969 Review.

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  Naryshkin S, Austin RM. Naryshkin S, et al. Drug Healthc Patient Saf. 2012;4:167-72. doi: 10.2147/DHPS.S37273. Epub 2012 Nov 2. Drug Healthc Patient Saf. 2012. PMID: 23152707 Free PMC article.

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  Wang M, Huang K, Wong MCS, Huang J, Jin Y, Zheng ZJ. Wang M, et al. J Epidemiol Glob Health. 2024 Mar;14(1):94-101. doi: 10.1007/s44197-023-00172-7. Epub 2024 Jan 3. J Epidemiol Glob Health. 2024. PMID: 38170398 Free PMC article.

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  Inturrisi F, Rozendaal L, Veldhuijzen NJ, Heideman DAM, Meijer CJLM, Berkhof J. Inturrisi F, et al. PLoS Med. 2022 Oct 28;19(10):e1004115. doi: 10.1371/journal.pmed.1004115. eCollection 2022 Oct. PLoS Med. 2022. PMID: 36306283 Free PMC article. Clinical Trial.

1. 1. Cuzick J, Szarewski A, Cubie H, Hulman G, Kitchener H, Luesley D, et al. Management of women who test positive for high-risk types of human papillomavirus: the HART study. Lancet. 2003 Dec 6;362(9399):1871–6. - PubMed
2. 1. Schiffman M, Herrero R, Hildesheim A, Sherman ME, Bratti M, Wacholder S, et al. HPV DNA testing in cervical cancer screening: results from women in a high-risk province of Costa Rica. JAMA. 2000 Jan 5;283(1):87–93. - PubMed
3. 1. Sherman ME, Lorincz AT, Scott DR, Wacholder S, Castle PE, Glass AG, et al. Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: a 10-year cohort analysis. J Natl Cancer Inst. 2003 Jan 1;95(1):46–52. - PubMed
4. 1. Anttila A, Kotaniemi-Talonen L, Leinonen M, Hakama M, Laurila P, Tarkkanen J, et al. Rate of cervical cancer, severe intraepithelial neoplasia, and adenocarcinoma in situ in primary HPV DNA screening with cytology triage: randomised study within organised screening programme. BMJ. 2010;340:c1804. - PMC - PubMed
5. 1. Bulkmans NW, Berkhof J, Rozendaal L, van Kemenade FJ, Boeke AJ, Bulk S, et al. Human papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomised controlled implementation trial. Lancet. 2007 Nov 24;370(9601):1764–72. - PubMed

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