A long-term prospective study of type-specific human papillomavirus infection and risk of cervical neoplasia among 20,000 women in the Portland Kaiser cohort study

Mark Schiffman, Andrew G. Glass, Nicolas Wentzensen, Brenda B. Rush, Philip E. Castle, David R. Scott, Julie Buckland, Mark E. Sherman, Greg Rydzak, Peter Kirk, Attila T. Lorincz, Sholom Wacholder, Robert D. Burk

Research output: Contribution to journalArticle

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Abstract

Background: Human papillomavirus (HPV) DNA testing is more sensitive than cytology for detection of cervical intraepithelial neoplasia grade 3 and cancer (≥CIN3). Adding HPV testing to cytology is recommended for women ≥30 but long-term prospective studies of HPV testing are rare. Methods: Beginning in 1989-1990, ∼20,000 women in a prepaid health maintenance organization (median age = 34) were followed passively by recommended annual cytology. We tested archived cervicovaginal lavage specimens collected at enrollment, primarily by MY09-MY11 PCR-based methods, for carcinogenic HPV types. We calculated positive and negative predictive values for the entire study period, and Kaplan-Meier estimates of cumulative probability for ≥CIN3, up to 18 years of follow-up. Results: We observed 47 cases of invasive cervical cancer during the study period, and 156 cases of CIN3. Predictive values and Kaplan-Meier analyses yielded the same conclusions. In women 30 and older, the reassurance against ≥CIN3 following a single negative HPV test was long-lasting (cumulative probability = 0.7% during follow-up). In this age group, a single HPV test (positive vs. negative, hazard ratio of 8.5, 95% CI = 4.8-15.1) provided greater long-term risk stratification than a single cytologic result (abnormal vs. normal, HR = 2.9, 95% CI = 1.2-6.6). The risk for ≥CIN3 was higher for HPV16 than for the average of the other carcinogenic types (hazard ratio = 2.7). Conclusion and Impact: The data from this cohort study show the long-term predictive value of HPV testing, particularly in women ≥30, and a possible role for distinguishing particularly carcinogenic types like HPV16.

Original languageEnglish (US)
Pages (from-to)1398-1409
Number of pages12
JournalCancer Epidemiology Biomarkers and Prevention
Volume20
Issue number7
DOIs
StatePublished - Jul 2011

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Papillomavirus Infections
Cervical Intraepithelial Neoplasia
Cohort Studies
Prospective Studies
Neoplasms
Cell Biology
Kaplan-Meier Estimate
Health Maintenance Organizations
Therapeutic Irrigation
Uterine Cervical Neoplasms
Age Groups
Polymerase Chain Reaction
DNA

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

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A long-term prospective study of type-specific human papillomavirus infection and risk of cervical neoplasia among 20,000 women in the Portland Kaiser cohort study. / Schiffman, Mark; Glass, Andrew G.; Wentzensen, Nicolas; Rush, Brenda B.; Castle, Philip E.; Scott, David R.; Buckland, Julie; Sherman, Mark E.; Rydzak, Greg; Kirk, Peter; Lorincz, Attila T.; Wacholder, Sholom; Burk, Robert D.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 20, No. 7, 07.2011, p. 1398-1409.

Research output: Contribution to journalArticle

Schiffman, Mark ; Glass, Andrew G. ; Wentzensen, Nicolas ; Rush, Brenda B. ; Castle, Philip E. ; Scott, David R. ; Buckland, Julie ; Sherman, Mark E. ; Rydzak, Greg ; Kirk, Peter ; Lorincz, Attila T. ; Wacholder, Sholom ; Burk, Robert D. / A long-term prospective study of type-specific human papillomavirus infection and risk of cervical neoplasia among 20,000 women in the Portland Kaiser cohort study. In: Cancer Epidemiology Biomarkers and Prevention. 2011 ; Vol. 20, No. 7. pp. 1398-1409.
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AU - Rush, Brenda B.

AU - Castle, Philip E.

AU - Scott, David R.

AU - Buckland, Julie

AU - Sherman, Mark E.

AU - Rydzak, Greg

AU - Kirk, Peter

AU - Lorincz, Attila T.

AU - Wacholder, Sholom

AU - Burk, Robert D.

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