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Long‐term risk of recurrent cervical human papillomavirus infection and precancer and cancer following excisional treatment
Author(s) -
Kreimer Aimée R.,
Schiffman Mark,
Herrero Rolando,
Hildesheim Allan,
González Paula,
Burk Robert D.,
Porras Carolina,
Sherman Mark E.,
Demuth Franklin,
Cheung Li,
Bratti Concepción,
Cecilia Rodríguez Ana
Publication year - 2011
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.26349
Subject(s) - medicine , colposcopy , cervical intraepithelial neoplasia , cervical cancer , interquartile range , cancer , cohort , gynecology , adenocarcinoma , cytology , carcinoma in situ , intraepithelial neoplasia , hpv infection , oncology , pathology , prostate
Risk of recurrent CIN2+ (including cervical intraepithelial neoplasia grade 2 [CIN2], CIN3, carcinoma and in situ , adenocarcinoma in situ or cancer) remains elevated for years following treatment. The role of long‐term post‐treatment human papillomavirus (HPV) presence on subsequent risk of CIN2+ was evaluated in the 10,049‐women Guanacaste cohort. Six hundred eighty‐one women were referred to colposcopy because of high‐grade cytology, positive cervicography and/or suspicion of cancer based on visual assessment; 486 were judged to require treatment. After excluding women with <12 months of follow‐up ( N = 88), prior cancer or hysterectomy ( N = 37) or other reasons ( N = 14), 347 were included in the analysis. Infections were categorized as persistent if present at both pre‐ and post‐treatment visits and new if detected only post‐treatment. Median time between the treatment and post‐treatment visits was 6.7 years (interquartile range 3.8–7.8). At the post‐treatment visit, 8 (2.4%), 2 (0.6%) and 8 (2.4%) of the 347 treated women had persistent HPV16, HPV18 or other carcinogenic HPV, respectively. Two (0.8%), 3 (1.0%) and 13 (4.0%) had new HPV16, HPV18 and other carcinogenic HPV, respectively. Six CIN2+ cases were identified at the post‐treatment visit, all with persistent infections (three HPV16, one HPV18 and two other carcinogenic HPV). No recurrent disease was observed among women with new HPV infections during the follow‐up period. Thus, persistence of HPV infection a median of six years after treatment was uncommon but, when present, posed a substantial risk of subsequent CIN2+. Serial follow‐up data from other studies would further strengthen these conclusions.