Role of Screening History in Clinical Meaning and Optimal Management of Positive Cervical Screening Results

Philip E. Castle, Walter K. Kinney, Xiaonan Xue, Li C. Cheung, Julia C. Gage, Nancy E. Poitras, Thomas S. Lorey, Hormuzd A. Katki, Nicolas Wentzensen, Mark Schiffman

Research output: Contribution to journalArticle

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Abstract

Cervical cancer is caused by persistent human papillomavirus (HPV) infection. US consensus management guidelines for a positive cervical screening result typically focus on the current screening result only. A negative testing history may alter risk of the following positive screening results, caused by a new HPV infection, and therefore its optimal management. Methods: Women ages 30 years and older were screened with triennial HPV and cytology co-testing at Kaiser Permanente Northern California from 2003 to 2014. We estimated the subsequent 5-year risks of cervical intraepithelial neoplasia grade 3 or more severe diagnoses (CIN3+) in a cohort of 1 156 387 women following abnormal (atypical squamous cells of undetermined significance [ASC-US] or worse) cytology and/or positive HPV testing, when the test result followed 0 (n = 990 013), 1 (n = 543 986), 2 (n = 245 974), or 3 (n = 79 946) consecutive negative co-test(s). All statistical tests were two-sided. Results: Following 0-3 successive negative co-tests, 5-year CIN3+ risks following a positive HPV test decreased progressively from 7.2% (95% CI = 7.0% to 7.4%) to 1.5% (95% CI = 0.7% to 3.4%) (Ptrend <. 001). Similarly, risks following an abnormal (ASC-US or worse) cytology result decreased from 6.6% (95% CI = 6.4% to 6.9%) to 1.1% (95% CI = 0.5% to 2.3%) (Ptrend <. 001). Risks following low-grade squamous intraepithelial lesion, the risk threshold for referral to colposcopy in the United States, decreased from 5.2% (95% CI = 4.7% to 5.7%) to 0.9% (95% CI = 0.2% to 4.3%). Risks following high-grade squamous intraepithelial lesion or more severe, a specific marker for the presence of precancerous lesions, decreased from 50.0% (95% CI = 47.5% to 52.5%) to 10.0% (95% CI = 2.6% to 34.4%). Conclusions: Following one or more sequential antecedent, documented negative co-tests or HPV tests, women with HPV-positive ASC-US or low-grade squamous intraepithelial lesion might have sufficiently low CIN3+ risk that they do not need colposcopy referral and might instead undergo 6-12-month surveillance for evidence of higher risk before being referred to colposcopy.

Original languageEnglish (US)
Pages (from-to)820-827
Number of pages8
JournalJournal of the National Cancer Institute
Volume111
Issue number8
DOIs
StatePublished - Aug 1 2019

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History
Colposcopy
Cell Biology
Papillomavirus Infections
Referral and Consultation
Cervical Intraepithelial Neoplasia
Uterine Cervical Neoplasms
Guidelines
Squamous Intraepithelial Lesions of the Cervix
Atypical Squamous Cells of the Cervix

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Role of Screening History in Clinical Meaning and Optimal Management of Positive Cervical Screening Results. / Castle, Philip E.; Kinney, Walter K.; Xue, Xiaonan; Cheung, Li C.; Gage, Julia C.; Poitras, Nancy E.; Lorey, Thomas S.; Katki, Hormuzd A.; Wentzensen, Nicolas; Schiffman, Mark.

In: Journal of the National Cancer Institute, Vol. 111, No. 8, 01.08.2019, p. 820-827.

Research output: Contribution to journalArticle

Castle, PE, Kinney, WK, Xue, X, Cheung, LC, Gage, JC, Poitras, NE, Lorey, TS, Katki, HA, Wentzensen, N & Schiffman, M 2019, 'Role of Screening History in Clinical Meaning and Optimal Management of Positive Cervical Screening Results', Journal of the National Cancer Institute, vol. 111, no. 8, pp. 820-827. https://doi.org/10.1093/jnci/djy192
Castle, Philip E. ; Kinney, Walter K. ; Xue, Xiaonan ; Cheung, Li C. ; Gage, Julia C. ; Poitras, Nancy E. ; Lorey, Thomas S. ; Katki, Hormuzd A. ; Wentzensen, Nicolas ; Schiffman, Mark. / Role of Screening History in Clinical Meaning and Optimal Management of Positive Cervical Screening Results. In: Journal of the National Cancer Institute. 2019 ; Vol. 111, No. 8. pp. 820-827.
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abstract = "Cervical cancer is caused by persistent human papillomavirus (HPV) infection. US consensus management guidelines for a positive cervical screening result typically focus on the current screening result only. A negative testing history may alter risk of the following positive screening results, caused by a new HPV infection, and therefore its optimal management. Methods: Women ages 30 years and older were screened with triennial HPV and cytology co-testing at Kaiser Permanente Northern California from 2003 to 2014. We estimated the subsequent 5-year risks of cervical intraepithelial neoplasia grade 3 or more severe diagnoses (CIN3+) in a cohort of 1 156 387 women following abnormal (atypical squamous cells of undetermined significance [ASC-US] or worse) cytology and/or positive HPV testing, when the test result followed 0 (n = 990 013), 1 (n = 543 986), 2 (n = 245 974), or 3 (n = 79 946) consecutive negative co-test(s). All statistical tests were two-sided. Results: Following 0-3 successive negative co-tests, 5-year CIN3+ risks following a positive HPV test decreased progressively from 7.2{\%} (95{\%} CI = 7.0{\%} to 7.4{\%}) to 1.5{\%} (95{\%} CI = 0.7{\%} to 3.4{\%}) (Ptrend <. 001). Similarly, risks following an abnormal (ASC-US or worse) cytology result decreased from 6.6{\%} (95{\%} CI = 6.4{\%} to 6.9{\%}) to 1.1{\%} (95{\%} CI = 0.5{\%} to 2.3{\%}) (Ptrend <. 001). Risks following low-grade squamous intraepithelial lesion, the risk threshold for referral to colposcopy in the United States, decreased from 5.2{\%} (95{\%} CI = 4.7{\%} to 5.7{\%}) to 0.9{\%} (95{\%} CI = 0.2{\%} to 4.3{\%}). Risks following high-grade squamous intraepithelial lesion or more severe, a specific marker for the presence of precancerous lesions, decreased from 50.0{\%} (95{\%} CI = 47.5{\%} to 52.5{\%}) to 10.0{\%} (95{\%} CI = 2.6{\%} to 34.4{\%}). Conclusions: Following one or more sequential antecedent, documented negative co-tests or HPV tests, women with HPV-positive ASC-US or low-grade squamous intraepithelial lesion might have sufficiently low CIN3+ risk that they do not need colposcopy referral and might instead undergo 6-12-month surveillance for evidence of higher risk before being referred to colposcopy.",
author = "Castle, {Philip E.} and Kinney, {Walter K.} and Xiaonan Xue and Cheung, {Li C.} and Gage, {Julia C.} and Poitras, {Nancy E.} and Lorey, {Thomas S.} and Katki, {Hormuzd A.} and Nicolas Wentzensen and Mark Schiffman",
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T1 - Role of Screening History in Clinical Meaning and Optimal Management of Positive Cervical Screening Results

AU - Castle, Philip E.

AU - Kinney, Walter K.

AU - Xue, Xiaonan

AU - Cheung, Li C.

AU - Gage, Julia C.

AU - Poitras, Nancy E.

AU - Lorey, Thomas S.

AU - Katki, Hormuzd A.

AU - Wentzensen, Nicolas

AU - Schiffman, Mark

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Cervical cancer is caused by persistent human papillomavirus (HPV) infection. US consensus management guidelines for a positive cervical screening result typically focus on the current screening result only. A negative testing history may alter risk of the following positive screening results, caused by a new HPV infection, and therefore its optimal management. Methods: Women ages 30 years and older were screened with triennial HPV and cytology co-testing at Kaiser Permanente Northern California from 2003 to 2014. We estimated the subsequent 5-year risks of cervical intraepithelial neoplasia grade 3 or more severe diagnoses (CIN3+) in a cohort of 1 156 387 women following abnormal (atypical squamous cells of undetermined significance [ASC-US] or worse) cytology and/or positive HPV testing, when the test result followed 0 (n = 990 013), 1 (n = 543 986), 2 (n = 245 974), or 3 (n = 79 946) consecutive negative co-test(s). All statistical tests were two-sided. Results: Following 0-3 successive negative co-tests, 5-year CIN3+ risks following a positive HPV test decreased progressively from 7.2% (95% CI = 7.0% to 7.4%) to 1.5% (95% CI = 0.7% to 3.4%) (Ptrend <. 001). Similarly, risks following an abnormal (ASC-US or worse) cytology result decreased from 6.6% (95% CI = 6.4% to 6.9%) to 1.1% (95% CI = 0.5% to 2.3%) (Ptrend <. 001). Risks following low-grade squamous intraepithelial lesion, the risk threshold for referral to colposcopy in the United States, decreased from 5.2% (95% CI = 4.7% to 5.7%) to 0.9% (95% CI = 0.2% to 4.3%). Risks following high-grade squamous intraepithelial lesion or more severe, a specific marker for the presence of precancerous lesions, decreased from 50.0% (95% CI = 47.5% to 52.5%) to 10.0% (95% CI = 2.6% to 34.4%). Conclusions: Following one or more sequential antecedent, documented negative co-tests or HPV tests, women with HPV-positive ASC-US or low-grade squamous intraepithelial lesion might have sufficiently low CIN3+ risk that they do not need colposcopy referral and might instead undergo 6-12-month surveillance for evidence of higher risk before being referred to colposcopy.

AB - Cervical cancer is caused by persistent human papillomavirus (HPV) infection. US consensus management guidelines for a positive cervical screening result typically focus on the current screening result only. A negative testing history may alter risk of the following positive screening results, caused by a new HPV infection, and therefore its optimal management. Methods: Women ages 30 years and older were screened with triennial HPV and cytology co-testing at Kaiser Permanente Northern California from 2003 to 2014. We estimated the subsequent 5-year risks of cervical intraepithelial neoplasia grade 3 or more severe diagnoses (CIN3+) in a cohort of 1 156 387 women following abnormal (atypical squamous cells of undetermined significance [ASC-US] or worse) cytology and/or positive HPV testing, when the test result followed 0 (n = 990 013), 1 (n = 543 986), 2 (n = 245 974), or 3 (n = 79 946) consecutive negative co-test(s). All statistical tests were two-sided. Results: Following 0-3 successive negative co-tests, 5-year CIN3+ risks following a positive HPV test decreased progressively from 7.2% (95% CI = 7.0% to 7.4%) to 1.5% (95% CI = 0.7% to 3.4%) (Ptrend <. 001). Similarly, risks following an abnormal (ASC-US or worse) cytology result decreased from 6.6% (95% CI = 6.4% to 6.9%) to 1.1% (95% CI = 0.5% to 2.3%) (Ptrend <. 001). Risks following low-grade squamous intraepithelial lesion, the risk threshold for referral to colposcopy in the United States, decreased from 5.2% (95% CI = 4.7% to 5.7%) to 0.9% (95% CI = 0.2% to 4.3%). Risks following high-grade squamous intraepithelial lesion or more severe, a specific marker for the presence of precancerous lesions, decreased from 50.0% (95% CI = 47.5% to 52.5%) to 10.0% (95% CI = 2.6% to 34.4%). Conclusions: Following one or more sequential antecedent, documented negative co-tests or HPV tests, women with HPV-positive ASC-US or low-grade squamous intraepithelial lesion might have sufficiently low CIN3+ risk that they do not need colposcopy referral and might instead undergo 6-12-month surveillance for evidence of higher risk before being referred to colposcopy.

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