Absolute risk of a subsequent abnormal Pap among oncogenic human papillomavirus DNA-positive, cytologically negative women

Philip E. Castle, Sholom Wacholder, Mark E. Sherman, Attila T. Lorincz, Andrew G. Glass, David R. Scott, Brenda B. Rush, Franklin Demuth, Mark Schiffman

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

BACKGROUND. The addition of human papillomavirus (HPV) DNA testing to cytologic screening for cervical carcinoma is now being considered. The majority of women in screening cohorts who test positive for oncogenic types of HPV DNA have concurrent negative Pap tests. The absolute risk of a subsequent abnormal Pap test for these women is uncertain. Therefore, the proper counseling and clinical management of these women is also uncertain. METHODS. A subcohort of 2020 women with a negative Pap test who tested positive at enrollment for oncogenic HPV DNA types using the Hybrid Capture 2 Test were followed for 57 months at Kaiser Permanente (Portland, OR). Absolute risks of new abnormal cytologic interpretations were computed using Kaplan-Meier methods. Logistic regression models were used to evaluate determinants of a new abnormal Pap test. RESULTS. The cumulative incidence for a Pap test interpreted as atypical squamous cells or more severe (≥ ASC) was 16.8% (95% confidence interval [CI] = 15.0-18.6%), 6.4% (95% CI = 5.2-7.6%) for low-grade squamous intraepithelial lesions or more severe, and 2.2% (95% CI = 1.5-2.9%) for high-grade squamous intraepithelial lesions or more severe. By comparison, the cumulative incidence of greater than or equal to ASC among HPV-negative women was 4.2% (95% CI = 3.9-4.6%). The highest viral load (100 relative light units per the positive control or greater) was associated with a greater risk of an abnormal Pap test (odds ratio= 2.7, 95% CI = 1.7-4.1) than lower viral loads. CONCLUSIONS. These results suggest that about 15% of women in annual screening programs who concurrently have a negative Pap test and a positive oncogenic HPV test will have a subsequent abnormal Pap test within 5 years. This risk estimate will be useful to the many clinicians and patients likely to be diagnosed with an HPV infection and negative cytology if HPV DNA is added to general screening.

Original languageEnglish (US)
Pages (from-to)2145-2151
Number of pages7
JournalCancer
Volume95
Issue number10
DOIs
StatePublished - Nov 15 2002
Externally publishedYes

Fingerprint

Papanicolaou Test
DNA
Confidence Intervals
Viral Load
Logistic Models
Papillomavirus Infections
Incidence
Cell Biology
Counseling
Odds Ratio
Carcinoma
Light

Keywords

  • Absolute risk
  • ASC
  • HPV
  • HSIL
  • LSIL
  • Pap

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Castle, P. E., Wacholder, S., Sherman, M. E., Lorincz, A. T., Glass, A. G., Scott, D. R., ... Schiffman, M. (2002). Absolute risk of a subsequent abnormal Pap among oncogenic human papillomavirus DNA-positive, cytologically negative women. Cancer, 95(10), 2145-2151. https://doi.org/10.1002/cncr.10927

Absolute risk of a subsequent abnormal Pap among oncogenic human papillomavirus DNA-positive, cytologically negative women. / Castle, Philip E.; Wacholder, Sholom; Sherman, Mark E.; Lorincz, Attila T.; Glass, Andrew G.; Scott, David R.; Rush, Brenda B.; Demuth, Franklin; Schiffman, Mark.

In: Cancer, Vol. 95, No. 10, 15.11.2002, p. 2145-2151.

Research output: Contribution to journalArticle

Castle, PE, Wacholder, S, Sherman, ME, Lorincz, AT, Glass, AG, Scott, DR, Rush, BB, Demuth, F & Schiffman, M 2002, 'Absolute risk of a subsequent abnormal Pap among oncogenic human papillomavirus DNA-positive, cytologically negative women', Cancer, vol. 95, no. 10, pp. 2145-2151. https://doi.org/10.1002/cncr.10927
Castle, Philip E. ; Wacholder, Sholom ; Sherman, Mark E. ; Lorincz, Attila T. ; Glass, Andrew G. ; Scott, David R. ; Rush, Brenda B. ; Demuth, Franklin ; Schiffman, Mark. / Absolute risk of a subsequent abnormal Pap among oncogenic human papillomavirus DNA-positive, cytologically negative women. In: Cancer. 2002 ; Vol. 95, No. 10. pp. 2145-2151.
@article{6c81b144e2dd4742a2a4f4568e8e9e63,
title = "Absolute risk of a subsequent abnormal Pap among oncogenic human papillomavirus DNA-positive, cytologically negative women",
abstract = "BACKGROUND. The addition of human papillomavirus (HPV) DNA testing to cytologic screening for cervical carcinoma is now being considered. The majority of women in screening cohorts who test positive for oncogenic types of HPV DNA have concurrent negative Pap tests. The absolute risk of a subsequent abnormal Pap test for these women is uncertain. Therefore, the proper counseling and clinical management of these women is also uncertain. METHODS. A subcohort of 2020 women with a negative Pap test who tested positive at enrollment for oncogenic HPV DNA types using the Hybrid Capture 2 Test were followed for 57 months at Kaiser Permanente (Portland, OR). Absolute risks of new abnormal cytologic interpretations were computed using Kaplan-Meier methods. Logistic regression models were used to evaluate determinants of a new abnormal Pap test. RESULTS. The cumulative incidence for a Pap test interpreted as atypical squamous cells or more severe (≥ ASC) was 16.8{\%} (95{\%} confidence interval [CI] = 15.0-18.6{\%}), 6.4{\%} (95{\%} CI = 5.2-7.6{\%}) for low-grade squamous intraepithelial lesions or more severe, and 2.2{\%} (95{\%} CI = 1.5-2.9{\%}) for high-grade squamous intraepithelial lesions or more severe. By comparison, the cumulative incidence of greater than or equal to ASC among HPV-negative women was 4.2{\%} (95{\%} CI = 3.9-4.6{\%}). The highest viral load (100 relative light units per the positive control or greater) was associated with a greater risk of an abnormal Pap test (odds ratio= 2.7, 95{\%} CI = 1.7-4.1) than lower viral loads. CONCLUSIONS. These results suggest that about 15{\%} of women in annual screening programs who concurrently have a negative Pap test and a positive oncogenic HPV test will have a subsequent abnormal Pap test within 5 years. This risk estimate will be useful to the many clinicians and patients likely to be diagnosed with an HPV infection and negative cytology if HPV DNA is added to general screening.",
keywords = "Absolute risk, ASC, HPV, HSIL, LSIL, Pap",
author = "Castle, {Philip E.} and Sholom Wacholder and Sherman, {Mark E.} and Lorincz, {Attila T.} and Glass, {Andrew G.} and Scott, {David R.} and Rush, {Brenda B.} and Franklin Demuth and Mark Schiffman",
year = "2002",
month = "11",
day = "15",
doi = "10.1002/cncr.10927",
language = "English (US)",
volume = "95",
pages = "2145--2151",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "10",

}

TY - JOUR

T1 - Absolute risk of a subsequent abnormal Pap among oncogenic human papillomavirus DNA-positive, cytologically negative women

AU - Castle, Philip E.

AU - Wacholder, Sholom

AU - Sherman, Mark E.

AU - Lorincz, Attila T.

AU - Glass, Andrew G.

AU - Scott, David R.

AU - Rush, Brenda B.

AU - Demuth, Franklin

AU - Schiffman, Mark

PY - 2002/11/15

Y1 - 2002/11/15

N2 - BACKGROUND. The addition of human papillomavirus (HPV) DNA testing to cytologic screening for cervical carcinoma is now being considered. The majority of women in screening cohorts who test positive for oncogenic types of HPV DNA have concurrent negative Pap tests. The absolute risk of a subsequent abnormal Pap test for these women is uncertain. Therefore, the proper counseling and clinical management of these women is also uncertain. METHODS. A subcohort of 2020 women with a negative Pap test who tested positive at enrollment for oncogenic HPV DNA types using the Hybrid Capture 2 Test were followed for 57 months at Kaiser Permanente (Portland, OR). Absolute risks of new abnormal cytologic interpretations were computed using Kaplan-Meier methods. Logistic regression models were used to evaluate determinants of a new abnormal Pap test. RESULTS. The cumulative incidence for a Pap test interpreted as atypical squamous cells or more severe (≥ ASC) was 16.8% (95% confidence interval [CI] = 15.0-18.6%), 6.4% (95% CI = 5.2-7.6%) for low-grade squamous intraepithelial lesions or more severe, and 2.2% (95% CI = 1.5-2.9%) for high-grade squamous intraepithelial lesions or more severe. By comparison, the cumulative incidence of greater than or equal to ASC among HPV-negative women was 4.2% (95% CI = 3.9-4.6%). The highest viral load (100 relative light units per the positive control or greater) was associated with a greater risk of an abnormal Pap test (odds ratio= 2.7, 95% CI = 1.7-4.1) than lower viral loads. CONCLUSIONS. These results suggest that about 15% of women in annual screening programs who concurrently have a negative Pap test and a positive oncogenic HPV test will have a subsequent abnormal Pap test within 5 years. This risk estimate will be useful to the many clinicians and patients likely to be diagnosed with an HPV infection and negative cytology if HPV DNA is added to general screening.

AB - BACKGROUND. The addition of human papillomavirus (HPV) DNA testing to cytologic screening for cervical carcinoma is now being considered. The majority of women in screening cohorts who test positive for oncogenic types of HPV DNA have concurrent negative Pap tests. The absolute risk of a subsequent abnormal Pap test for these women is uncertain. Therefore, the proper counseling and clinical management of these women is also uncertain. METHODS. A subcohort of 2020 women with a negative Pap test who tested positive at enrollment for oncogenic HPV DNA types using the Hybrid Capture 2 Test were followed for 57 months at Kaiser Permanente (Portland, OR). Absolute risks of new abnormal cytologic interpretations were computed using Kaplan-Meier methods. Logistic regression models were used to evaluate determinants of a new abnormal Pap test. RESULTS. The cumulative incidence for a Pap test interpreted as atypical squamous cells or more severe (≥ ASC) was 16.8% (95% confidence interval [CI] = 15.0-18.6%), 6.4% (95% CI = 5.2-7.6%) for low-grade squamous intraepithelial lesions or more severe, and 2.2% (95% CI = 1.5-2.9%) for high-grade squamous intraepithelial lesions or more severe. By comparison, the cumulative incidence of greater than or equal to ASC among HPV-negative women was 4.2% (95% CI = 3.9-4.6%). The highest viral load (100 relative light units per the positive control or greater) was associated with a greater risk of an abnormal Pap test (odds ratio= 2.7, 95% CI = 1.7-4.1) than lower viral loads. CONCLUSIONS. These results suggest that about 15% of women in annual screening programs who concurrently have a negative Pap test and a positive oncogenic HPV test will have a subsequent abnormal Pap test within 5 years. This risk estimate will be useful to the many clinicians and patients likely to be diagnosed with an HPV infection and negative cytology if HPV DNA is added to general screening.

KW - Absolute risk

KW - ASC

KW - HPV

KW - HSIL

KW - LSIL

KW - Pap

UR - http://www.scopus.com/inward/record.url?scp=0037110649&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037110649&partnerID=8YFLogxK

U2 - 10.1002/cncr.10927

DO - 10.1002/cncr.10927

M3 - Article

VL - 95

SP - 2145

EP - 2151

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 10

ER -