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Cancer Prev Res (Phila). 2015 Jun;8(6):502-8. doi: 10.1158/1940-6207.CAPR-14-0409. Epub 2015 Mar 16.

Five-Year Cervical (Pre)Cancer Risk of Women Screened by HPV and Cytology Testing.

Author information

1
Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.
2
Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands.
3
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
4
Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands. cjlm.meijer@vumc.nl.

Abstract

Primary human papillomavirus (HPV)-based cervical screening will be introduced in the Netherlands in 2016. We assessed the 5-year cervical (pre)cancer risk of women with different combinations of HPV and cytology test results. Special attention was paid to risks for cervical intraepithelial neoplasia grade 3 and 2 or more (CIN3+/2+) of HPV-positive women with a negative triage test, because this determines the safety of a 5-year screening interval for HPV-positive, triage test-negative women. In addition, age-related effects were studied. A total of 25,553 women were screened by HPV testing and cytology in a screening setting. Women were managed on the presence of HPV and/or abnormal cytology. Five-year cumulative incidences for CIN3+/2+ were calculated. Five-year CIN3+(2+) risk was 10.0% (17.7%) among HPV-positive women. When stratified by cytology, the CIN3+(CIN2+) risk was 7.9% (12.9%) for women with normal cytology and 22.2% (45.3%) for women with equivocal or mildly abnormal (i.e., BMD) cytology. For HPV-negative women, the 5-year CIN3+(2+) risk was 0.09% (0.21%). Additional triage of HPV-positive women with normal cytology by repeat cytology at 12 months showed a 5-year CIN3+(2+) risk of 4.1% (7.0%). HPV-non 16/18-positive women with normal cytology at baseline had comparable risks of 3.5% (7.9%). HPV-non 16/18-positive women with normal baseline cytology and normal repeat cytology had a 5-year CIN3+ risk of 0.42%. No age-related effects were detected. In conclusion, HPV-positive women with normal cytology and a negative triage test, either repeat cytology after 12 months or baseline HPV 16/18 genotyping, develop a non-negligible CIN3+ risk over 5 years. Therefore, extension of the screening interval over 5 years only seems possible for HPV screen-negative women.

PMID:
25776933
DOI:
10.1158/1940-6207.CAPR-14-0409
[Indexed for MEDLINE]
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