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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
Author(s) -
Bulk Saskia,
Bulkmans Nicole W.J.,
Berkhof Johannes,
Rozendaal Lawrence,
P. Boeke A. Joan,
Verheijen René H.M.,
Snijders Peter J.F.,
Meijer Chris J.L.M.
Publication year - 2007
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.22677
Subject(s) - colposcopy , medicine , cervical intraepithelial neoplasia , cytology , gynecology , population , obstetrics , papillomaviridae , cervical screening , cervical cancer , cancer , pathology , environmental health
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. Notably, 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 dyskaryosis and normal cytology 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. © 2007 Wiley‐Liss, Inc.