Risk stratification using human papillomavirus testing among women with equivocally abnormal cytology: Results from a state-wide surveillance program

New Mexico HPV Pap Registry Steering Committee

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Clinical guidelines for cervical cancer screening have incorporated comparative risks of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) for various screening outcomes to determine management. Few cohorts are large enough to distinguish CIN3+ risks among women with minor abnormalities versus negative cytology because of low incidence. The New Mexico Human Papillomavirus (HPV) Pap Registry offers a unique opportunity to evaluate cervical cancer screening in a diverse population across a broad-spectrum of health service delivery. Methods: Kaplan-Meier and logistic-Weibull survival models were used to estimate cumulative risks of CIN3+ among women ages 21 to 64 who were screened in New Mexico between 2007 and 2011 with negative, equivocal or mildly abnormal cytology, that is, atypical squamous cells of undetermined significance (ASC-US; with or without HPV triage), or low-grade squamous intraepithelial lesions (LSIL). Results: We identified 452,045 women meeting the selection criteria. The 3-year CIN3+ risks for women with negative, ASC-US, and LSIL cytology were 0.30%, 2.6%, and 5.2%, respectively. HPV triage of ASC-US stratified 3-year CIN3+ risks were 0.72% for HPV-negative and 7.7% for HPV-positive. Risks tended to decline after age 30 for all screening results. Conclusions: In this state-wide population-based cohort, cytology and HPV triage of ASC-US stratified women's CIN3+ risk into similar patterns observed previously, suggesting the validity of screening guidelines for diverse populations in the United States. Absolute risk estimates should be compared across other large populations. Impact: Strategies for HPV triage of ASC-US derived from clinical trials are upheld in large clinical practice settings and across diverse screening populations in the United States.

Original languageEnglish (US)
Pages (from-to)36-42
Number of pages7
JournalCancer Epidemiology Biomarkers and Prevention
Volume25
Issue number1
DOIs
StatePublished - Jan 1 2016

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Cell Biology
Triage
Population
Early Detection of Cancer
Uterine Cervical Neoplasms
Guidelines
Cervical Intraepithelial Neoplasia
Patient Selection
Health Services
Registries
Atypical Squamous Cells of the Cervix
Clinical Trials
Survival
Incidence
Neoplasms

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

Risk stratification using human papillomavirus testing among women with equivocally abnormal cytology : Results from a state-wide surveillance program. / New Mexico HPV Pap Registry Steering Committee.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 25, No. 1, 01.01.2016, p. 36-42.

Research output: Contribution to journalArticle

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title = "Risk stratification using human papillomavirus testing among women with equivocally abnormal cytology: Results from a state-wide surveillance program",
abstract = "Background: Clinical guidelines for cervical cancer screening have incorporated comparative risks of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) for various screening outcomes to determine management. Few cohorts are large enough to distinguish CIN3+ risks among women with minor abnormalities versus negative cytology because of low incidence. The New Mexico Human Papillomavirus (HPV) Pap Registry offers a unique opportunity to evaluate cervical cancer screening in a diverse population across a broad-spectrum of health service delivery. Methods: Kaplan-Meier and logistic-Weibull survival models were used to estimate cumulative risks of CIN3+ among women ages 21 to 64 who were screened in New Mexico between 2007 and 2011 with negative, equivocal or mildly abnormal cytology, that is, atypical squamous cells of undetermined significance (ASC-US; with or without HPV triage), or low-grade squamous intraepithelial lesions (LSIL). Results: We identified 452,045 women meeting the selection criteria. The 3-year CIN3+ risks for women with negative, ASC-US, and LSIL cytology were 0.30{\%}, 2.6{\%}, and 5.2{\%}, respectively. HPV triage of ASC-US stratified 3-year CIN3+ risks were 0.72{\%} for HPV-negative and 7.7{\%} for HPV-positive. Risks tended to decline after age 30 for all screening results. Conclusions: In this state-wide population-based cohort, cytology and HPV triage of ASC-US stratified women's CIN3+ risk into similar patterns observed previously, suggesting the validity of screening guidelines for diverse populations in the United States. Absolute risk estimates should be compared across other large populations. Impact: Strategies for HPV triage of ASC-US derived from clinical trials are upheld in large clinical practice settings and across diverse screening populations in the United States.",
author = "{New Mexico HPV Pap Registry Steering Committee} and Gage, {Julia C.} and Hunt, {William C.} and Mark Schiffman and Katki, {Hormuzd A.} and Cheung, {Li C.} and Jack Cuzick and Orrin Myers and Castle, {Philip E.} and Wheeler, {Cosette M.}",
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T1 - Risk stratification using human papillomavirus testing among women with equivocally abnormal cytology

T2 - Results from a state-wide surveillance program

AU - New Mexico HPV Pap Registry Steering Committee

AU - Gage, Julia C.

AU - Hunt, William C.

AU - Schiffman, Mark

AU - Katki, Hormuzd A.

AU - Cheung, Li C.

AU - Cuzick, Jack

AU - Myers, Orrin

AU - Castle, Philip E.

AU - Wheeler, Cosette M.

PY - 2016/1/1

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N2 - Background: Clinical guidelines for cervical cancer screening have incorporated comparative risks of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) for various screening outcomes to determine management. Few cohorts are large enough to distinguish CIN3+ risks among women with minor abnormalities versus negative cytology because of low incidence. The New Mexico Human Papillomavirus (HPV) Pap Registry offers a unique opportunity to evaluate cervical cancer screening in a diverse population across a broad-spectrum of health service delivery. Methods: Kaplan-Meier and logistic-Weibull survival models were used to estimate cumulative risks of CIN3+ among women ages 21 to 64 who were screened in New Mexico between 2007 and 2011 with negative, equivocal or mildly abnormal cytology, that is, atypical squamous cells of undetermined significance (ASC-US; with or without HPV triage), or low-grade squamous intraepithelial lesions (LSIL). Results: We identified 452,045 women meeting the selection criteria. The 3-year CIN3+ risks for women with negative, ASC-US, and LSIL cytology were 0.30%, 2.6%, and 5.2%, respectively. HPV triage of ASC-US stratified 3-year CIN3+ risks were 0.72% for HPV-negative and 7.7% for HPV-positive. Risks tended to decline after age 30 for all screening results. Conclusions: In this state-wide population-based cohort, cytology and HPV triage of ASC-US stratified women's CIN3+ risk into similar patterns observed previously, suggesting the validity of screening guidelines for diverse populations in the United States. Absolute risk estimates should be compared across other large populations. Impact: Strategies for HPV triage of ASC-US derived from clinical trials are upheld in large clinical practice settings and across diverse screening populations in the United States.

AB - Background: Clinical guidelines for cervical cancer screening have incorporated comparative risks of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) for various screening outcomes to determine management. Few cohorts are large enough to distinguish CIN3+ risks among women with minor abnormalities versus negative cytology because of low incidence. The New Mexico Human Papillomavirus (HPV) Pap Registry offers a unique opportunity to evaluate cervical cancer screening in a diverse population across a broad-spectrum of health service delivery. Methods: Kaplan-Meier and logistic-Weibull survival models were used to estimate cumulative risks of CIN3+ among women ages 21 to 64 who were screened in New Mexico between 2007 and 2011 with negative, equivocal or mildly abnormal cytology, that is, atypical squamous cells of undetermined significance (ASC-US; with or without HPV triage), or low-grade squamous intraepithelial lesions (LSIL). Results: We identified 452,045 women meeting the selection criteria. The 3-year CIN3+ risks for women with negative, ASC-US, and LSIL cytology were 0.30%, 2.6%, and 5.2%, respectively. HPV triage of ASC-US stratified 3-year CIN3+ risks were 0.72% for HPV-negative and 7.7% for HPV-positive. Risks tended to decline after age 30 for all screening results. Conclusions: In this state-wide population-based cohort, cytology and HPV triage of ASC-US stratified women's CIN3+ risk into similar patterns observed previously, suggesting the validity of screening guidelines for diverse populations in the United States. Absolute risk estimates should be compared across other large populations. Impact: Strategies for HPV triage of ASC-US derived from clinical trials are upheld in large clinical practice settings and across diverse screening populations in the United States.

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