Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: A 10-year cohort analysis

Mark E. Sherman, Attila T. Lorincz, David R. Scott, Sholom Wacholder, Philip E. Castle, Andrew G. Glass, Iwona Mielzynska-Lohnas, Brenda B. Rush, Mark Schiffman

Research output: Contribution to journalArticle

359 Citations (Scopus)

Abstract

Background: Annual Pap smear screening has been favored over less frequent screening in the United States to minimize the risk of cervical cancer. We evaluated whether simultaneous screening with a Pap test and human papillomavirus (HPV) testing is useful for assessing the risk for cervical intraepithelial neoplasia (CIN) 3 or cervical cancer. Methods: We enrolled 23702 subjects in a study of HPV infection at Kaiser Permanente, Northwest Division, Portland, OR. Data were analyzed for 20810 volunteers who were at least 16 years old (mean = 35.9 years) with satisfactory baseline Pap tests and suitable samples for HPV testing. Women were followed for up to 122 months (from April 1, 1989, to June 30, 1999) to determine the risk for histopathologically confirmed CIN3 or cancer. Results: Among 171 women with CIN3 or cancer diagnosed over 122 months, 123 (71.9%, 95% confidence interval [CI] = 65.2% to 78.7%) had baseline Pap results of atypical squamous cells or worse and/or a positive HPV test, including 102 (86.4%, 95% CI = 80.3% to 92.6%) of the 118 cases diagnosed within the first 45 months of follow-up. During this 45-month period, the cumulative incidence of CIN3 or cancer was 4.54% (95% CI = 3.61% to 5.46%) among women with a Pap test result of atypical squamous cells or worse, positive HPV tests, or both compared with 0.16% (95% CI = 0.08% to 0.24%) among women with negative Pap and HPV tests. Age, screening behavior, a history of cervical cancer precursors, and a history of treatment for CIN minimally affected results. Conclusions: Negative baseline Pap and HPV tests were associated with a low risk for CIN3 or cancer in the subsequent 45 months, largely because a negative HPV test was associated with a decreased risk of cervical neoplasia. Negative combined test results should provide added reassurance for lengthening the screening interval among low-risk women, whereas positive results identify a relatively small subgroup that requires more frequent surveillance.

Original languageEnglish (US)
Pages (from-to)46-52
Number of pages7
JournalJournal of the National Cancer Institute
Volume95
Issue number1
StatePublished - Jan 1 2003
Externally publishedYes

Fingerprint

antineoplaston A10
Cell Biology
Cohort Studies
Papanicolaou Test
Neoplasms
Uterine Cervical Neoplasms
Confidence Intervals
Cervical Intraepithelial Neoplasia
Papillomavirus Infections
Volunteers
Incidence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Sherman, M. E., Lorincz, A. T., Scott, D. R., Wacholder, S., Castle, P. E., Glass, A. G., ... Schiffman, M. (2003). Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: A 10-year cohort analysis. Journal of the National Cancer Institute, 95(1), 46-52.

Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia : A 10-year cohort analysis. / Sherman, Mark E.; Lorincz, Attila T.; Scott, David R.; Wacholder, Sholom; Castle, Philip E.; Glass, Andrew G.; Mielzynska-Lohnas, Iwona; Rush, Brenda B.; Schiffman, Mark.

In: Journal of the National Cancer Institute, Vol. 95, No. 1, 01.01.2003, p. 46-52.

Research output: Contribution to journalArticle

Sherman, ME, Lorincz, AT, Scott, DR, Wacholder, S, Castle, PE, Glass, AG, Mielzynska-Lohnas, I, Rush, BB & Schiffman, M 2003, 'Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: A 10-year cohort analysis', Journal of the National Cancer Institute, vol. 95, no. 1, pp. 46-52.
Sherman, Mark E. ; Lorincz, Attila T. ; Scott, David R. ; Wacholder, Sholom ; Castle, Philip E. ; Glass, Andrew G. ; Mielzynska-Lohnas, Iwona ; Rush, Brenda B. ; Schiffman, Mark. / Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia : A 10-year cohort analysis. In: Journal of the National Cancer Institute. 2003 ; Vol. 95, No. 1. pp. 46-52.
@article{ba3f5396447d4156bb271e264f68e367,
title = "Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: A 10-year cohort analysis",
abstract = "Background: Annual Pap smear screening has been favored over less frequent screening in the United States to minimize the risk of cervical cancer. We evaluated whether simultaneous screening with a Pap test and human papillomavirus (HPV) testing is useful for assessing the risk for cervical intraepithelial neoplasia (CIN) 3 or cervical cancer. Methods: We enrolled 23702 subjects in a study of HPV infection at Kaiser Permanente, Northwest Division, Portland, OR. Data were analyzed for 20810 volunteers who were at least 16 years old (mean = 35.9 years) with satisfactory baseline Pap tests and suitable samples for HPV testing. Women were followed for up to 122 months (from April 1, 1989, to June 30, 1999) to determine the risk for histopathologically confirmed CIN3 or cancer. Results: Among 171 women with CIN3 or cancer diagnosed over 122 months, 123 (71.9{\%}, 95{\%} confidence interval [CI] = 65.2{\%} to 78.7{\%}) had baseline Pap results of atypical squamous cells or worse and/or a positive HPV test, including 102 (86.4{\%}, 95{\%} CI = 80.3{\%} to 92.6{\%}) of the 118 cases diagnosed within the first 45 months of follow-up. During this 45-month period, the cumulative incidence of CIN3 or cancer was 4.54{\%} (95{\%} CI = 3.61{\%} to 5.46{\%}) among women with a Pap test result of atypical squamous cells or worse, positive HPV tests, or both compared with 0.16{\%} (95{\%} CI = 0.08{\%} to 0.24{\%}) among women with negative Pap and HPV tests. Age, screening behavior, a history of cervical cancer precursors, and a history of treatment for CIN minimally affected results. Conclusions: Negative baseline Pap and HPV tests were associated with a low risk for CIN3 or cancer in the subsequent 45 months, largely because a negative HPV test was associated with a decreased risk of cervical neoplasia. Negative combined test results should provide added reassurance for lengthening the screening interval among low-risk women, whereas positive results identify a relatively small subgroup that requires more frequent surveillance.",
author = "Sherman, {Mark E.} and Lorincz, {Attila T.} and Scott, {David R.} and Sholom Wacholder and Castle, {Philip E.} and Glass, {Andrew G.} and Iwona Mielzynska-Lohnas and Rush, {Brenda B.} and Mark Schiffman",
year = "2003",
month = "1",
day = "1",
language = "English (US)",
volume = "95",
pages = "46--52",
journal = "Journal of the National Cancer Institute",
issn = "0027-8874",
publisher = "Oxford University Press",
number = "1",

}

TY - JOUR

T1 - Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia

T2 - A 10-year cohort analysis

AU - Sherman, Mark E.

AU - Lorincz, Attila T.

AU - Scott, David R.

AU - Wacholder, Sholom

AU - Castle, Philip E.

AU - Glass, Andrew G.

AU - Mielzynska-Lohnas, Iwona

AU - Rush, Brenda B.

AU - Schiffman, Mark

PY - 2003/1/1

Y1 - 2003/1/1

N2 - Background: Annual Pap smear screening has been favored over less frequent screening in the United States to minimize the risk of cervical cancer. We evaluated whether simultaneous screening with a Pap test and human papillomavirus (HPV) testing is useful for assessing the risk for cervical intraepithelial neoplasia (CIN) 3 or cervical cancer. Methods: We enrolled 23702 subjects in a study of HPV infection at Kaiser Permanente, Northwest Division, Portland, OR. Data were analyzed for 20810 volunteers who were at least 16 years old (mean = 35.9 years) with satisfactory baseline Pap tests and suitable samples for HPV testing. Women were followed for up to 122 months (from April 1, 1989, to June 30, 1999) to determine the risk for histopathologically confirmed CIN3 or cancer. Results: Among 171 women with CIN3 or cancer diagnosed over 122 months, 123 (71.9%, 95% confidence interval [CI] = 65.2% to 78.7%) had baseline Pap results of atypical squamous cells or worse and/or a positive HPV test, including 102 (86.4%, 95% CI = 80.3% to 92.6%) of the 118 cases diagnosed within the first 45 months of follow-up. During this 45-month period, the cumulative incidence of CIN3 or cancer was 4.54% (95% CI = 3.61% to 5.46%) among women with a Pap test result of atypical squamous cells or worse, positive HPV tests, or both compared with 0.16% (95% CI = 0.08% to 0.24%) among women with negative Pap and HPV tests. Age, screening behavior, a history of cervical cancer precursors, and a history of treatment for CIN minimally affected results. Conclusions: Negative baseline Pap and HPV tests were associated with a low risk for CIN3 or cancer in the subsequent 45 months, largely because a negative HPV test was associated with a decreased risk of cervical neoplasia. Negative combined test results should provide added reassurance for lengthening the screening interval among low-risk women, whereas positive results identify a relatively small subgroup that requires more frequent surveillance.

AB - Background: Annual Pap smear screening has been favored over less frequent screening in the United States to minimize the risk of cervical cancer. We evaluated whether simultaneous screening with a Pap test and human papillomavirus (HPV) testing is useful for assessing the risk for cervical intraepithelial neoplasia (CIN) 3 or cervical cancer. Methods: We enrolled 23702 subjects in a study of HPV infection at Kaiser Permanente, Northwest Division, Portland, OR. Data were analyzed for 20810 volunteers who were at least 16 years old (mean = 35.9 years) with satisfactory baseline Pap tests and suitable samples for HPV testing. Women were followed for up to 122 months (from April 1, 1989, to June 30, 1999) to determine the risk for histopathologically confirmed CIN3 or cancer. Results: Among 171 women with CIN3 or cancer diagnosed over 122 months, 123 (71.9%, 95% confidence interval [CI] = 65.2% to 78.7%) had baseline Pap results of atypical squamous cells or worse and/or a positive HPV test, including 102 (86.4%, 95% CI = 80.3% to 92.6%) of the 118 cases diagnosed within the first 45 months of follow-up. During this 45-month period, the cumulative incidence of CIN3 or cancer was 4.54% (95% CI = 3.61% to 5.46%) among women with a Pap test result of atypical squamous cells or worse, positive HPV tests, or both compared with 0.16% (95% CI = 0.08% to 0.24%) among women with negative Pap and HPV tests. Age, screening behavior, a history of cervical cancer precursors, and a history of treatment for CIN minimally affected results. Conclusions: Negative baseline Pap and HPV tests were associated with a low risk for CIN3 or cancer in the subsequent 45 months, largely because a negative HPV test was associated with a decreased risk of cervical neoplasia. Negative combined test results should provide added reassurance for lengthening the screening interval among low-risk women, whereas positive results identify a relatively small subgroup that requires more frequent surveillance.

UR - http://www.scopus.com/inward/record.url?scp=0037251859&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037251859&partnerID=8YFLogxK

M3 - Article

C2 - 12509400

AN - SCOPUS:0037251859

VL - 95

SP - 46

EP - 52

JO - Journal of the National Cancer Institute

JF - Journal of the National Cancer Institute

SN - 0027-8874

IS - 1

ER -