High-risk and low-risk human papillomavirus and the absolute risk of cervical intraepithelial neoplasia or cancer

Louise T. Thomsen, Kirsten Frederiksen, Christian Munk, Jette Junge, Philip E. Castle, Thomas Iftner, Susanne K. Kjaer

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective: To determine the absolute risk of cervical intraepithelial neoplasia (CIN) grade 3 or cervical cancer (CIN 3 or worse) after detection of low-risk human papillomavirus (HPV) and after a negative high-risk HPV test. Methods: In this prospective cohort study, consecutive liquid-based cervical cytology samples were collected from women screened for cervical cancer in Copenhagen, Denmark, during 2002-2005. Samples were tested with a clinical test for 13 high-risk and five low-risk HPV types. The cohort (N535,539; aged 14-90 years) was monitored in a nationwide pathology register for up to 10.5 years for development of CIN 3 or worse. Results: The 8-year absolute risk of CIN 3 or worse was 1.1% (95% confidence interval [CI] 1.0-1.3%) for HPV-negative women; 1.7% (0.8-2.6%) for low-risk HPV-positive women without concurrent high-risk HPV; 17.4% (16.4-18.5%) for high-risk HPV-positive women without concurrent low-risk HPV; and 15.9% (13.5- 18.3%) for women with concurrent high-risk and low-risk HPV. The 8-year absolute risk of CIN 3 or worse after a negative high-risk HPV test (irrespective of low-risk HPV status) was lower than after a normal cytology result among women aged younger than 30 years (3.5% [95% CI, 2.9-4.0%] compared with 6.9% [6.2-7.5%], P,.001) and women aged 30 years or older (0.7% [95% CI, 0.6- 0.9%] compared with 1.8% [95% CI, 1.6-2.0%], P,.001). Conclusion: A negative high-risk HPV test provides greater long-term reassurance against CIN 3 or worse than normal cytology. Detection of low-risk HPV does not predict CIN 3 or worse. Cervical cancer screening should not include testing for low-risk HPV types.

Original languageEnglish (US)
Pages (from-to)57-64
Number of pages8
JournalObstetrics and Gynecology
Volume123
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

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Cervical Intraepithelial Neoplasia
Neoplasms
Uterine Cervical Neoplasms
Confidence Intervals
Cell Biology

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

High-risk and low-risk human papillomavirus and the absolute risk of cervical intraepithelial neoplasia or cancer. / Thomsen, Louise T.; Frederiksen, Kirsten; Munk, Christian; Junge, Jette; Castle, Philip E.; Iftner, Thomas; Kjaer, Susanne K.

In: Obstetrics and Gynecology, Vol. 123, No. 1, 2014, p. 57-64.

Research output: Contribution to journalArticle

Thomsen, Louise T. ; Frederiksen, Kirsten ; Munk, Christian ; Junge, Jette ; Castle, Philip E. ; Iftner, Thomas ; Kjaer, Susanne K. / High-risk and low-risk human papillomavirus and the absolute risk of cervical intraepithelial neoplasia or cancer. In: Obstetrics and Gynecology. 2014 ; Vol. 123, No. 1. pp. 57-64.
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T1 - High-risk and low-risk human papillomavirus and the absolute risk of cervical intraepithelial neoplasia or cancer

AU - Thomsen, Louise T.

AU - Frederiksen, Kirsten

AU - Munk, Christian

AU - Junge, Jette

AU - Castle, Philip E.

AU - Iftner, Thomas

AU - Kjaer, Susanne K.

PY - 2014

Y1 - 2014

N2 - Objective: To determine the absolute risk of cervical intraepithelial neoplasia (CIN) grade 3 or cervical cancer (CIN 3 or worse) after detection of low-risk human papillomavirus (HPV) and after a negative high-risk HPV test. Methods: In this prospective cohort study, consecutive liquid-based cervical cytology samples were collected from women screened for cervical cancer in Copenhagen, Denmark, during 2002-2005. Samples were tested with a clinical test for 13 high-risk and five low-risk HPV types. The cohort (N535,539; aged 14-90 years) was monitored in a nationwide pathology register for up to 10.5 years for development of CIN 3 or worse. Results: The 8-year absolute risk of CIN 3 or worse was 1.1% (95% confidence interval [CI] 1.0-1.3%) for HPV-negative women; 1.7% (0.8-2.6%) for low-risk HPV-positive women without concurrent high-risk HPV; 17.4% (16.4-18.5%) for high-risk HPV-positive women without concurrent low-risk HPV; and 15.9% (13.5- 18.3%) for women with concurrent high-risk and low-risk HPV. The 8-year absolute risk of CIN 3 or worse after a negative high-risk HPV test (irrespective of low-risk HPV status) was lower than after a normal cytology result among women aged younger than 30 years (3.5% [95% CI, 2.9-4.0%] compared with 6.9% [6.2-7.5%], P,.001) and women aged 30 years or older (0.7% [95% CI, 0.6- 0.9%] compared with 1.8% [95% CI, 1.6-2.0%], P,.001). Conclusion: A negative high-risk HPV test provides greater long-term reassurance against CIN 3 or worse than normal cytology. Detection of low-risk HPV does not predict CIN 3 or worse. Cervical cancer screening should not include testing for low-risk HPV types.

AB - Objective: To determine the absolute risk of cervical intraepithelial neoplasia (CIN) grade 3 or cervical cancer (CIN 3 or worse) after detection of low-risk human papillomavirus (HPV) and after a negative high-risk HPV test. Methods: In this prospective cohort study, consecutive liquid-based cervical cytology samples were collected from women screened for cervical cancer in Copenhagen, Denmark, during 2002-2005. Samples were tested with a clinical test for 13 high-risk and five low-risk HPV types. The cohort (N535,539; aged 14-90 years) was monitored in a nationwide pathology register for up to 10.5 years for development of CIN 3 or worse. Results: The 8-year absolute risk of CIN 3 or worse was 1.1% (95% confidence interval [CI] 1.0-1.3%) for HPV-negative women; 1.7% (0.8-2.6%) for low-risk HPV-positive women without concurrent high-risk HPV; 17.4% (16.4-18.5%) for high-risk HPV-positive women without concurrent low-risk HPV; and 15.9% (13.5- 18.3%) for women with concurrent high-risk and low-risk HPV. The 8-year absolute risk of CIN 3 or worse after a negative high-risk HPV test (irrespective of low-risk HPV status) was lower than after a normal cytology result among women aged younger than 30 years (3.5% [95% CI, 2.9-4.0%] compared with 6.9% [6.2-7.5%], P,.001) and women aged 30 years or older (0.7% [95% CI, 0.6- 0.9%] compared with 1.8% [95% CI, 1.6-2.0%], P,.001). Conclusion: A negative high-risk HPV test provides greater long-term reassurance against CIN 3 or worse than normal cytology. Detection of low-risk HPV does not predict CIN 3 or worse. Cervical cancer screening should not include testing for low-risk HPV types.

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