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Cancer Epidemiol Biomarkers Prev. 2013 Jun;22(6):1095-101. doi: 10.1158/1055-9965.EPI-12-1455. Epub 2013 Apr 19.

Risk of precancer determined by HPV genotype combinations in women with minor cytologic abnormalities.

Author information

1
Divisions of Cancer Epidemiology and Genetics and Cancer Prevention National Cancer Institute, Department of Health and Human Services, NIH, Bethesda, MD 20852, USA. gagej@mail.nih.gov

Abstract

BACKGROUND:

Studies suggest that testing for individual human papillomavirus (HPV) genotypes can improve risk stratification in women with minor cytologic abnormalities. We evaluated genotyping for HPV16, HPV16/18, and HPV16/18/45 in carcinogenic HPV-positive women with atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) cytology.

METHODS:

For women enrolled in the ASCUS-LSIL Triage Study (ALTS), we calculated the age-stratified (<30 and 30+ years) positivity and cumulative risk over two years of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) when testing positive or negative for three genotype combinations: HPV16, HPV16/18, and HPV16/18/45.

RESULTS:

Among women with ASCUS cytology, HPV16 positivity was 17.1% and increased to 22.0% (P < 0.001) for HPV16/18 and 25.6% (P < 0.001) for HPV16/18/45. Among women with LSIL cytology, HPV16 positivity was 21.1% and increased to 30.0% (P < 0.001) for HPV16/18 and 34.0% (P = 0.017) for HPV16/18/45. Regardless of cytology and age group, the greatest risk difference between test positives and test negatives was observed for HPV16 with decreasing risk stratification for HPV16/18 and HPV16/18/45. However, testing negative for any of the three combinations while being positive for another carcinogenic type still implied a two-year risk of CIN3+ of 7.8% or more.

CONCLUSIONS:

Although genotyping for HPV16, 18, and 45 provided additional risk stratification in carcinogenic HPV-positive women with minor cytologic abnormalities, the risk among genotype-negative women was still high enough to warrant immediate colposcopy referral.

IMPACT:

HPV genotyping in HPV-positive women with minor cytologic abnormalities will likely not alter clinical management. Adding HPV45 to genotyping assays is not warranted.

PMID:
23603204
PMCID:
PMC3687215
DOI:
10.1158/1055-9965.EPI-12-1455
[Indexed for MEDLINE]
Free PMC Article
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