Five-year risks of CIN 3+ and cervical cancer among women with HPV testing of ASC-US pap results

Hormuzd A. Katki, Mark Schiffman, Philip E. Castle, Barbara Fetterman, Nancy E. Poitras, Thomas Lorey, Li C. Cheung, Tina Raine-Bennett, Julia C. Gage, Walter K. Kinney

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: New screening guidelines recommend that human papillomavirus (HPV)-negative/atypical squamous cells of undetermined significance (ASC-US) results be considered as equivalent to HPV-negative/Pap-negative results, leading to rescreening in 5 years. However, despite ample data, the routine clinical performance of HPV testing of women with ASC-US has not been adequately documented. METHODS: We estimated 5-year risks of cervical intraepithelial neoplasia (CIN) 3+ and of cancer among 2 groups of women between 2003 and 2010 at Kaiser Permanente Northern California: 27,050 aged 30 to 64 years who underwent HPV and Pap cotesting and had an ASC-US Pap result and 12,209 aged 25 to 29 years who underwent HPV triage of ASC-US. RESULTS: Five-year risks of CIN 3+ and of cancer among women aged 30 to 64 years testing HPV-negative/ASC-US and among 923,152 women testing Pap-negative alone were similar although statistically distinguishable (CIN 3+, 0.43% vs 0.26%, p = .001; cancer, 0.050% vs 0.025%, p = .1). The increased risk of cancer after HPV-negative/ASC-US versus Pap-negative alone was confined to women aged 60 to 64 years (0.26% vs 0.035%, p = .3). Five-year risks of CIN 3+ and cancer among women with HPV-negative/ASC-US results were substantially higher than those among women testing HPV-negative/Pap-negative (CIN 3+, 0.43% vs 0.08%, p < .0001; cancer, 0.050% vs 0.011%, p = .003). For women aged 30 to 64 years testing HPV-positive/ASC-US, 5-year risks of CIN 3+ and cancer were slightly higher than those among 9,374 women with low-grade squamous intraepithelial lesion (LSIL) (CIN 3+, 6.8% vs 5.2%, p = .0007; cancer, 0.41% vs 0.16%, p = .04). Similar patterns were seen for women aged 25 to 29 years. CONCLUSIONS: Women with HPV-negative/ASC-US had a similar risk as women testing Pap-negative alone but had a higher risk than women testing HPV-negative/Pap-negative. Based upon the principle of "equal management of equal risks," our findings support the equal management of women with HPV-negative/ASC-US and those with Pap-negative alone, except for exiting women from screening because cancer risks at ages 60 to 64 years may be higher for women testing HPV-negative/ASC-US. Our findings also support managing HPV-positive/ASC-US and LSIL similarly.

Original languageEnglish (US)
JournalJournal of Lower Genital Tract Disease
Volume17
Issue number5 SUPPL.1
DOIs
StatePublished - Apr 2013

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Cervical Intraepithelial Neoplasia
Uterine Cervical Neoplasms
Neoplasms
Atypical Squamous Cells of the Cervix
Triage
Risk Management
Early Detection of Cancer

Keywords

  • ASC-US
  • Cervical intraepithelial neoplasia (CIN)
  • Human papillomavirus (HPV)
  • Pap

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Five-year risks of CIN 3+ and cervical cancer among women with HPV testing of ASC-US pap results. / Katki, Hormuzd A.; Schiffman, Mark; Castle, Philip E.; Fetterman, Barbara; Poitras, Nancy E.; Lorey, Thomas; Cheung, Li C.; Raine-Bennett, Tina; Gage, Julia C.; Kinney, Walter K.

In: Journal of Lower Genital Tract Disease, Vol. 17, No. 5 SUPPL.1, 04.2013.

Research output: Contribution to journalArticle

Katki, HA, Schiffman, M, Castle, PE, Fetterman, B, Poitras, NE, Lorey, T, Cheung, LC, Raine-Bennett, T, Gage, JC & Kinney, WK 2013, 'Five-year risks of CIN 3+ and cervical cancer among women with HPV testing of ASC-US pap results', Journal of Lower Genital Tract Disease, vol. 17, no. 5 SUPPL.1. https://doi.org/10.1097/LGT.0b013e3182854253
Katki, Hormuzd A. ; Schiffman, Mark ; Castle, Philip E. ; Fetterman, Barbara ; Poitras, Nancy E. ; Lorey, Thomas ; Cheung, Li C. ; Raine-Bennett, Tina ; Gage, Julia C. ; Kinney, Walter K. / Five-year risks of CIN 3+ and cervical cancer among women with HPV testing of ASC-US pap results. In: Journal of Lower Genital Tract Disease. 2013 ; Vol. 17, No. 5 SUPPL.1.
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abstract = "OBJECTIVE: New screening guidelines recommend that human papillomavirus (HPV)-negative/atypical squamous cells of undetermined significance (ASC-US) results be considered as equivalent to HPV-negative/Pap-negative results, leading to rescreening in 5 years. However, despite ample data, the routine clinical performance of HPV testing of women with ASC-US has not been adequately documented. METHODS: We estimated 5-year risks of cervical intraepithelial neoplasia (CIN) 3+ and of cancer among 2 groups of women between 2003 and 2010 at Kaiser Permanente Northern California: 27,050 aged 30 to 64 years who underwent HPV and Pap cotesting and had an ASC-US Pap result and 12,209 aged 25 to 29 years who underwent HPV triage of ASC-US. RESULTS: Five-year risks of CIN 3+ and of cancer among women aged 30 to 64 years testing HPV-negative/ASC-US and among 923,152 women testing Pap-negative alone were similar although statistically distinguishable (CIN 3+, 0.43{\%} vs 0.26{\%}, p = .001; cancer, 0.050{\%} vs 0.025{\%}, p = .1). The increased risk of cancer after HPV-negative/ASC-US versus Pap-negative alone was confined to women aged 60 to 64 years (0.26{\%} vs 0.035{\%}, p = .3). Five-year risks of CIN 3+ and cancer among women with HPV-negative/ASC-US results were substantially higher than those among women testing HPV-negative/Pap-negative (CIN 3+, 0.43{\%} vs 0.08{\%}, p < .0001; cancer, 0.050{\%} vs 0.011{\%}, p = .003). For women aged 30 to 64 years testing HPV-positive/ASC-US, 5-year risks of CIN 3+ and cancer were slightly higher than those among 9,374 women with low-grade squamous intraepithelial lesion (LSIL) (CIN 3+, 6.8{\%} vs 5.2{\%}, p = .0007; cancer, 0.41{\%} vs 0.16{\%}, p = .04). Similar patterns were seen for women aged 25 to 29 years. CONCLUSIONS: Women with HPV-negative/ASC-US had a similar risk as women testing Pap-negative alone but had a higher risk than women testing HPV-negative/Pap-negative. Based upon the principle of {"}equal management of equal risks,{"} our findings support the equal management of women with HPV-negative/ASC-US and those with Pap-negative alone, except for exiting women from screening because cancer risks at ages 60 to 64 years may be higher for women testing HPV-negative/ASC-US. Our findings also support managing HPV-positive/ASC-US and LSIL similarly.",
keywords = "ASC-US, Cervical intraepithelial neoplasia (CIN), Human papillomavirus (HPV), Pap",
author = "Katki, {Hormuzd A.} and Mark Schiffman and Castle, {Philip E.} and Barbara Fetterman and Poitras, {Nancy E.} and Thomas Lorey and Cheung, {Li C.} and Tina Raine-Bennett and Gage, {Julia C.} and Kinney, {Walter K.}",
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T1 - Five-year risks of CIN 3+ and cervical cancer among women with HPV testing of ASC-US pap results

AU - Katki, Hormuzd A.

AU - Schiffman, Mark

AU - Castle, Philip E.

AU - Fetterman, Barbara

AU - Poitras, Nancy E.

AU - Lorey, Thomas

AU - Cheung, Li C.

AU - Raine-Bennett, Tina

AU - Gage, Julia C.

AU - Kinney, Walter K.

PY - 2013/4

Y1 - 2013/4

N2 - OBJECTIVE: New screening guidelines recommend that human papillomavirus (HPV)-negative/atypical squamous cells of undetermined significance (ASC-US) results be considered as equivalent to HPV-negative/Pap-negative results, leading to rescreening in 5 years. However, despite ample data, the routine clinical performance of HPV testing of women with ASC-US has not been adequately documented. METHODS: We estimated 5-year risks of cervical intraepithelial neoplasia (CIN) 3+ and of cancer among 2 groups of women between 2003 and 2010 at Kaiser Permanente Northern California: 27,050 aged 30 to 64 years who underwent HPV and Pap cotesting and had an ASC-US Pap result and 12,209 aged 25 to 29 years who underwent HPV triage of ASC-US. RESULTS: Five-year risks of CIN 3+ and of cancer among women aged 30 to 64 years testing HPV-negative/ASC-US and among 923,152 women testing Pap-negative alone were similar although statistically distinguishable (CIN 3+, 0.43% vs 0.26%, p = .001; cancer, 0.050% vs 0.025%, p = .1). The increased risk of cancer after HPV-negative/ASC-US versus Pap-negative alone was confined to women aged 60 to 64 years (0.26% vs 0.035%, p = .3). Five-year risks of CIN 3+ and cancer among women with HPV-negative/ASC-US results were substantially higher than those among women testing HPV-negative/Pap-negative (CIN 3+, 0.43% vs 0.08%, p < .0001; cancer, 0.050% vs 0.011%, p = .003). For women aged 30 to 64 years testing HPV-positive/ASC-US, 5-year risks of CIN 3+ and cancer were slightly higher than those among 9,374 women with low-grade squamous intraepithelial lesion (LSIL) (CIN 3+, 6.8% vs 5.2%, p = .0007; cancer, 0.41% vs 0.16%, p = .04). Similar patterns were seen for women aged 25 to 29 years. CONCLUSIONS: Women with HPV-negative/ASC-US had a similar risk as women testing Pap-negative alone but had a higher risk than women testing HPV-negative/Pap-negative. Based upon the principle of "equal management of equal risks," our findings support the equal management of women with HPV-negative/ASC-US and those with Pap-negative alone, except for exiting women from screening because cancer risks at ages 60 to 64 years may be higher for women testing HPV-negative/ASC-US. Our findings also support managing HPV-positive/ASC-US and LSIL similarly.

AB - OBJECTIVE: New screening guidelines recommend that human papillomavirus (HPV)-negative/atypical squamous cells of undetermined significance (ASC-US) results be considered as equivalent to HPV-negative/Pap-negative results, leading to rescreening in 5 years. However, despite ample data, the routine clinical performance of HPV testing of women with ASC-US has not been adequately documented. METHODS: We estimated 5-year risks of cervical intraepithelial neoplasia (CIN) 3+ and of cancer among 2 groups of women between 2003 and 2010 at Kaiser Permanente Northern California: 27,050 aged 30 to 64 years who underwent HPV and Pap cotesting and had an ASC-US Pap result and 12,209 aged 25 to 29 years who underwent HPV triage of ASC-US. RESULTS: Five-year risks of CIN 3+ and of cancer among women aged 30 to 64 years testing HPV-negative/ASC-US and among 923,152 women testing Pap-negative alone were similar although statistically distinguishable (CIN 3+, 0.43% vs 0.26%, p = .001; cancer, 0.050% vs 0.025%, p = .1). The increased risk of cancer after HPV-negative/ASC-US versus Pap-negative alone was confined to women aged 60 to 64 years (0.26% vs 0.035%, p = .3). Five-year risks of CIN 3+ and cancer among women with HPV-negative/ASC-US results were substantially higher than those among women testing HPV-negative/Pap-negative (CIN 3+, 0.43% vs 0.08%, p < .0001; cancer, 0.050% vs 0.011%, p = .003). For women aged 30 to 64 years testing HPV-positive/ASC-US, 5-year risks of CIN 3+ and cancer were slightly higher than those among 9,374 women with low-grade squamous intraepithelial lesion (LSIL) (CIN 3+, 6.8% vs 5.2%, p = .0007; cancer, 0.41% vs 0.16%, p = .04). Similar patterns were seen for women aged 25 to 29 years. CONCLUSIONS: Women with HPV-negative/ASC-US had a similar risk as women testing Pap-negative alone but had a higher risk than women testing HPV-negative/Pap-negative. Based upon the principle of "equal management of equal risks," our findings support the equal management of women with HPV-negative/ASC-US and those with Pap-negative alone, except for exiting women from screening because cancer risks at ages 60 to 64 years may be higher for women testing HPV-negative/ASC-US. Our findings also support managing HPV-positive/ASC-US and LSIL similarly.

KW - ASC-US

KW - Cervical intraepithelial neoplasia (CIN)

KW - Human papillomavirus (HPV)

KW - Pap

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