Adult; Cervical Intraepithelial Neoplasia/diagnosis/virology; Colposcopy/methods/standards; Double-Blind Method; Female; Follow-Up Studies; Humans; Mass Screening/methods/standards; Middle Aged; Papillomavirus Infections/diagnosis; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Time Factors; Uterine Cervical Neoplasms/diagnosis/virology; Vaginal Smears/methods/standards
Abstract :
[en] Adding a test for high-risk human papillomavirus (hrHPV) to cytological screening enhances the detection of high-grade cervical intraepithelial neoplasia (>or=CIN2), but data are required that enable long-term evaluation of screening. We investigated the >or=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 >or=CIN2 diagnosed within 36 months. hrHPV testing was more sensitive than cytology for >or=CIN2 (relative sensitivity 1.4, 95%CI: 1.3-1.5; absolute sensitivity 94.1 and 68.0%, respectively). The 18-month >or=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 >or=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 >or=CIN2 risk. Notably, women who had a double negative repeat test at 6 months had a >or=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 >or=CIN2 risk of 0% (95%CI: 0.0-0.8). Using hrHPV and/or cytology testing, risk of >or=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.
Disciplines :
Genetics & genetic processes
Author, co-author :
BULK, Saskia ; Centre Hospitalier Universitaire de Liège - CHU > Génétique
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.
Language :
English
Title :
Risk of high-grade cervical intra-epithelial neoplasia based on cytology and high-risk HPV testing at baseline and at 6-months.
Publication date :
2007
Journal title :
International Journal of Cancer
ISSN :
0020-7136
eISSN :
1097-0215
Publisher :
John Wiley & Sons, Hoboken, United States - New York
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