Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines

Maria Demarco, Thomas S. Lorey, Barbara Fetterman, Li C. Cheung, Richard S. Guido, Nicolas Wentzensen, Walter K. Kinney, Nancy E. Poitras, Brian Befano, Philip E. Castle, Mark Schiffman

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objectives The next round of the American Society for Colposcopy and Cervical Pathology (ASCCP)-sponsored cervical cancer screening and management guidelines will recommend clinical actions based on risk, rather than test-based algorithms. This article gives preliminary risk estimates for the screening setting, showing combinations of the 2 most important predictors, human papillomavirus (HPV) status and cytology result. Materials and Methods Among 1,262,713 women aged 25 to 77 years co-tested with HC2 (Qiagen) and cytology at Kaiser Permanente Northern California, we estimated 0-5-year cumulative risk of cervical intraepithelial neoplasia (CIN) 2+, CIN 3+, and cancer for combinations of cytology (negative for intraepithelial lesion or malignancy [NILM], atypical squamous cells of undetermined significance [ASC-US], low-grade squamous intraepithelial lesion [LSIL], atypical squamous cells cannot exclude HSIL [ASC-H], high-grade squamous intraepithelial lesion [HSIL], atypical glandular cells [AGC]) and HPV status. Results Ninety percent of screened women had HPV-negative NILM and an extremely low risk of subsequent cancer. Five-year risks of CIN 3+ were lower after HPV negativity (0.12%) than after NILM (0.25%). Among HPV-negative women, 5-year risks for CIN 3+ were 0.10% for NILM, 0.44% for ASC-US, 1.8% for LSIL, 3.0% for ASC-H, 1.2% for AGC, and 29% for HSIL+ cytology (which was very rare). Among HPV-positive women, 5-year risks were 4.0% for NILM, 6.8% for ASC-US, 6.1% for LSIL, 28% for ASC-H, 30% for AGC, and 50% for HSIL+ cytology. Conclusions As a foundation for the next guidelines revision, we confirmed with additional precision the risk estimates previously reported for combinations of HPV and cytology. Future analyses will estimate risks for women being followed in colposcopy clinic and posttreatment and will consider the role of risk modifiers such as age, HPV vaccine status, HPV type, and screening and treatment history.

Original languageEnglish (US)
Pages (from-to)261-267
Number of pages7
JournalJournal of Lower Genital Tract Disease
Volume21
Issue number4
DOIs
StatePublished - Oct 1 2017

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Cervical Intraepithelial Neoplasia
Cell Biology
Guidelines
Neoplasms
Colposcopy
Papillomavirus Vaccines
Squamous Intraepithelial Lesions of the Cervix
Early Detection of Cancer
Uterine Cervical Neoplasms
Atypical Squamous Cells of the Cervix
History
Pathology

Keywords

  • cervical cancer
  • management guidelines
  • screening

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status : The Foundation of Risk-Based Cervical Screening Guidelines. / Demarco, Maria; Lorey, Thomas S.; Fetterman, Barbara; Cheung, Li C.; Guido, Richard S.; Wentzensen, Nicolas; Kinney, Walter K.; Poitras, Nancy E.; Befano, Brian; Castle, Philip E.; Schiffman, Mark.

In: Journal of Lower Genital Tract Disease, Vol. 21, No. 4, 01.10.2017, p. 261-267.

Research output: Contribution to journalArticle

Demarco, M, Lorey, TS, Fetterman, B, Cheung, LC, Guido, RS, Wentzensen, N, Kinney, WK, Poitras, NE, Befano, B, Castle, PE & Schiffman, M 2017, 'Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines', Journal of Lower Genital Tract Disease, vol. 21, no. 4, pp. 261-267. https://doi.org/10.1097/LGT.0000000000000343
Demarco, Maria ; Lorey, Thomas S. ; Fetterman, Barbara ; Cheung, Li C. ; Guido, Richard S. ; Wentzensen, Nicolas ; Kinney, Walter K. ; Poitras, Nancy E. ; Befano, Brian ; Castle, Philip E. ; Schiffman, Mark. / Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status : The Foundation of Risk-Based Cervical Screening Guidelines. In: Journal of Lower Genital Tract Disease. 2017 ; Vol. 21, No. 4. pp. 261-267.
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abstract = "Objectives The next round of the American Society for Colposcopy and Cervical Pathology (ASCCP)-sponsored cervical cancer screening and management guidelines will recommend clinical actions based on risk, rather than test-based algorithms. This article gives preliminary risk estimates for the screening setting, showing combinations of the 2 most important predictors, human papillomavirus (HPV) status and cytology result. Materials and Methods Among 1,262,713 women aged 25 to 77 years co-tested with HC2 (Qiagen) and cytology at Kaiser Permanente Northern California, we estimated 0-5-year cumulative risk of cervical intraepithelial neoplasia (CIN) 2+, CIN 3+, and cancer for combinations of cytology (negative for intraepithelial lesion or malignancy [NILM], atypical squamous cells of undetermined significance [ASC-US], low-grade squamous intraepithelial lesion [LSIL], atypical squamous cells cannot exclude HSIL [ASC-H], high-grade squamous intraepithelial lesion [HSIL], atypical glandular cells [AGC]) and HPV status. Results Ninety percent of screened women had HPV-negative NILM and an extremely low risk of subsequent cancer. Five-year risks of CIN 3+ were lower after HPV negativity (0.12{\%}) than after NILM (0.25{\%}). Among HPV-negative women, 5-year risks for CIN 3+ were 0.10{\%} for NILM, 0.44{\%} for ASC-US, 1.8{\%} for LSIL, 3.0{\%} for ASC-H, 1.2{\%} for AGC, and 29{\%} for HSIL+ cytology (which was very rare). Among HPV-positive women, 5-year risks were 4.0{\%} for NILM, 6.8{\%} for ASC-US, 6.1{\%} for LSIL, 28{\%} for ASC-H, 30{\%} for AGC, and 50{\%} for HSIL+ cytology. Conclusions As a foundation for the next guidelines revision, we confirmed with additional precision the risk estimates previously reported for combinations of HPV and cytology. Future analyses will estimate risks for women being followed in colposcopy clinic and posttreatment and will consider the role of risk modifiers such as age, HPV vaccine status, HPV type, and screening and treatment history.",
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T2 - The Foundation of Risk-Based Cervical Screening Guidelines

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AU - Lorey, Thomas S.

AU - Fetterman, Barbara

AU - Cheung, Li C.

AU - Guido, Richard S.

AU - Wentzensen, Nicolas

AU - Kinney, Walter K.

AU - Poitras, Nancy E.

AU - Befano, Brian

AU - Castle, Philip E.

AU - Schiffman, Mark

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N2 - Objectives The next round of the American Society for Colposcopy and Cervical Pathology (ASCCP)-sponsored cervical cancer screening and management guidelines will recommend clinical actions based on risk, rather than test-based algorithms. This article gives preliminary risk estimates for the screening setting, showing combinations of the 2 most important predictors, human papillomavirus (HPV) status and cytology result. Materials and Methods Among 1,262,713 women aged 25 to 77 years co-tested with HC2 (Qiagen) and cytology at Kaiser Permanente Northern California, we estimated 0-5-year cumulative risk of cervical intraepithelial neoplasia (CIN) 2+, CIN 3+, and cancer for combinations of cytology (negative for intraepithelial lesion or malignancy [NILM], atypical squamous cells of undetermined significance [ASC-US], low-grade squamous intraepithelial lesion [LSIL], atypical squamous cells cannot exclude HSIL [ASC-H], high-grade squamous intraepithelial lesion [HSIL], atypical glandular cells [AGC]) and HPV status. Results Ninety percent of screened women had HPV-negative NILM and an extremely low risk of subsequent cancer. Five-year risks of CIN 3+ were lower after HPV negativity (0.12%) than after NILM (0.25%). Among HPV-negative women, 5-year risks for CIN 3+ were 0.10% for NILM, 0.44% for ASC-US, 1.8% for LSIL, 3.0% for ASC-H, 1.2% for AGC, and 29% for HSIL+ cytology (which was very rare). Among HPV-positive women, 5-year risks were 4.0% for NILM, 6.8% for ASC-US, 6.1% for LSIL, 28% for ASC-H, 30% for AGC, and 50% for HSIL+ cytology. Conclusions As a foundation for the next guidelines revision, we confirmed with additional precision the risk estimates previously reported for combinations of HPV and cytology. Future analyses will estimate risks for women being followed in colposcopy clinic and posttreatment and will consider the role of risk modifiers such as age, HPV vaccine status, HPV type, and screening and treatment history.

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