Clinical human papillomavirus detection forecasts cervical cancer risk in women over 18 years of follow-up

Philip E. Castle, Andrew G. Glass, Brenda B. Rush, David R. Scott, Nicolas Wentzensen, Julia C. Gage, Julie Buckland, Greg Rydzak, Attila T. Lorincz, Sholom Wacholder

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Purpose: To describe the long-term (≥ 10 years) benefits of clinical human papillomavirus (HPV) DNA testing for cervical precancer and cancer risk prediction. Methods: Cervicovaginal lavages collected from 19,512 women attending a health maintenance program were retrospectively tested for HPV using a clinical test. HPV positives were tested for HPV16 and HPV18 individually using a research test. A Papanicolaou (Pap) result classified as atypical squamous cells of undetermined significance (ASC-US) or more severe was considered abnormal. Women underwent follow-up prospectively with routine annual Pap testing up to 18 years. Cumulative incidence rates (CIRs) of ≥ grade 3 cervical intraepithelial neoplasia (CIN3+) or cancer for enrollment test results were calculated. Results: A baseline negative HPV test provided greater reassurance against CIN3+ over the 18-year follow-up than a normal Pap (CIR, 0.90% v 1.27%). Although both baseline Pap and HPV tests predicted who would develop CIN3+ within the first 2 years of follow-up, only HPV testing predicted who would develop CIN3+ 10 to 18 years later (P = .004). HPV16- and HPV18-positive women with normal Pap were at elevated risk of CIN3+ compared with other HPV-positive women with normal Pap and were at similar risk of CIN3+ compared with women with a low-grade squamous intraepithelial Pap. Conclusion: HPV testing to rule out cervical disease followed by Pap testing and possibly combined with the detection of HPV16 and HPV18 among HPV positives to identify those at immediate risk of CIN3+ would be an efficient algorithm for cervical cancer screening, especially in women age 30 years or older.

Original languageEnglish (US)
Pages (from-to)3044-3050
Number of pages7
JournalJournal of Clinical Oncology
Volume30
Issue number25
DOIs
StatePublished - Sep 1 2012
Externally publishedYes

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Uterine Cervical Neoplasms
Cervical Intraepithelial Neoplasia
Therapeutic Irrigation
Incidence
Early Detection of Cancer
DNA
Health
Research

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Clinical human papillomavirus detection forecasts cervical cancer risk in women over 18 years of follow-up. / Castle, Philip E.; Glass, Andrew G.; Rush, Brenda B.; Scott, David R.; Wentzensen, Nicolas; Gage, Julia C.; Buckland, Julie; Rydzak, Greg; Lorincz, Attila T.; Wacholder, Sholom.

In: Journal of Clinical Oncology, Vol. 30, No. 25, 01.09.2012, p. 3044-3050.

Research output: Contribution to journalArticle

Castle, PE, Glass, AG, Rush, BB, Scott, DR, Wentzensen, N, Gage, JC, Buckland, J, Rydzak, G, Lorincz, AT & Wacholder, S 2012, 'Clinical human papillomavirus detection forecasts cervical cancer risk in women over 18 years of follow-up', Journal of Clinical Oncology, vol. 30, no. 25, pp. 3044-3050. https://doi.org/10.1200/JCO.2011.38.8389
Castle, Philip E. ; Glass, Andrew G. ; Rush, Brenda B. ; Scott, David R. ; Wentzensen, Nicolas ; Gage, Julia C. ; Buckland, Julie ; Rydzak, Greg ; Lorincz, Attila T. ; Wacholder, Sholom. / Clinical human papillomavirus detection forecasts cervical cancer risk in women over 18 years of follow-up. In: Journal of Clinical Oncology. 2012 ; Vol. 30, No. 25. pp. 3044-3050.
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abstract = "Purpose: To describe the long-term (≥ 10 years) benefits of clinical human papillomavirus (HPV) DNA testing for cervical precancer and cancer risk prediction. Methods: Cervicovaginal lavages collected from 19,512 women attending a health maintenance program were retrospectively tested for HPV using a clinical test. HPV positives were tested for HPV16 and HPV18 individually using a research test. A Papanicolaou (Pap) result classified as atypical squamous cells of undetermined significance (ASC-US) or more severe was considered abnormal. Women underwent follow-up prospectively with routine annual Pap testing up to 18 years. Cumulative incidence rates (CIRs) of ≥ grade 3 cervical intraepithelial neoplasia (CIN3+) or cancer for enrollment test results were calculated. Results: A baseline negative HPV test provided greater reassurance against CIN3+ over the 18-year follow-up than a normal Pap (CIR, 0.90{\%} v 1.27{\%}). Although both baseline Pap and HPV tests predicted who would develop CIN3+ within the first 2 years of follow-up, only HPV testing predicted who would develop CIN3+ 10 to 18 years later (P = .004). HPV16- and HPV18-positive women with normal Pap were at elevated risk of CIN3+ compared with other HPV-positive women with normal Pap and were at similar risk of CIN3+ compared with women with a low-grade squamous intraepithelial Pap. Conclusion: HPV testing to rule out cervical disease followed by Pap testing and possibly combined with the detection of HPV16 and HPV18 among HPV positives to identify those at immediate risk of CIN3+ would be an efficient algorithm for cervical cancer screening, especially in women age 30 years or older.",
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AU - Gage, Julia C.

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N2 - Purpose: To describe the long-term (≥ 10 years) benefits of clinical human papillomavirus (HPV) DNA testing for cervical precancer and cancer risk prediction. Methods: Cervicovaginal lavages collected from 19,512 women attending a health maintenance program were retrospectively tested for HPV using a clinical test. HPV positives were tested for HPV16 and HPV18 individually using a research test. A Papanicolaou (Pap) result classified as atypical squamous cells of undetermined significance (ASC-US) or more severe was considered abnormal. Women underwent follow-up prospectively with routine annual Pap testing up to 18 years. Cumulative incidence rates (CIRs) of ≥ grade 3 cervical intraepithelial neoplasia (CIN3+) or cancer for enrollment test results were calculated. Results: A baseline negative HPV test provided greater reassurance against CIN3+ over the 18-year follow-up than a normal Pap (CIR, 0.90% v 1.27%). Although both baseline Pap and HPV tests predicted who would develop CIN3+ within the first 2 years of follow-up, only HPV testing predicted who would develop CIN3+ 10 to 18 years later (P = .004). HPV16- and HPV18-positive women with normal Pap were at elevated risk of CIN3+ compared with other HPV-positive women with normal Pap and were at similar risk of CIN3+ compared with women with a low-grade squamous intraepithelial Pap. Conclusion: HPV testing to rule out cervical disease followed by Pap testing and possibly combined with the detection of HPV16 and HPV18 among HPV positives to identify those at immediate risk of CIN3+ would be an efficient algorithm for cervical cancer screening, especially in women age 30 years or older.

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