Short term persistence of human papillomavirus and risk of cervical precancer and cancer: Population based cohort study

Philip E. Castle, Ana Cecilia Rodríguez, Robert D. Burk, Rolando Herrero, Sholom Wacholder, Mario Alfaro, Jorge Morales, Diego Guillen, Mark E. Sherman, Diane Solomon, Mark Schiffman

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

Objective: To evaluate the cumulative incidence of cervical intraepithelial neoplasia II or worse (grade II+) or cervical intraepithelial neoplasia grade III+ after short term persistence of prevalently detected carcinogenic human papillomavirus (HPV). Design: Population based cohort study. Setting: Guanacaste, Costa Rica. Participants: 2282 sexually active women actively followed after enrolment. Main outcome measures: Primary end points: three year and five year cumulative incidence of histologically confirmed cervical intraepithelial neoplasia grade II+ (n=70). Cervical specimens collected at each visit tested for more than 40 HPV genotypes. HPV 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, and 82 were considered the primary carcinogenic genotypes. Results: Women who tested positive for a carcinogenic HPV at enrolment and after about one year (9-21 months) (positive/positive) had a three year cumulative incidence of cervical intraepithelial neoplasia grade II+ of 17.0% (95% confidence interval 12.1% to 22.0%). Those who tested negative/positive (3.4%, 0.1% to 6.8%), positive/negative (1.2%, -0.2% to 2.5%), and negative/negative (0.5%, 0.1% to 0.9%) were at a significantly lower risk. There was little difference in the cumulative incidence of cervical intraepithelial neoplasia grade II+ between testing positive twice for any carcinogenic HPV genotype (same genotype or different genotypes) v testing positive twice for the same carcinogenic genotype (17.0% v 21.3%, respectively). Short term persistence of HPV 16 strongly predicted cervical intraepithelial neoplasia grade II+, with a three year cumulative incidence of 40.8% (26.4% to 55.1%). Similar patterns were observed for the five year cumulative incidence of grade II+ and for three year and five year cumulative incidence of grade III+. Conclusions: Short term persistence of a prevalently detected carcinogenic HPV infection, especially HPV 16, strongly predicts a subsequent diagnosis of cervical intraepithelial neoplasia II+ over the next few years.

Original languageEnglish (US)
Pages (from-to)327
Number of pages1
JournalBMJ (Online)
Volume339
Issue number7716
DOIs
StatePublished - Aug 8 2009

Fingerprint

Cervical Intraepithelial Neoplasia
Uterine Cervical Neoplasms
Cohort Studies
Genotype
Incidence
Human papillomavirus 16
Population
Costa Rica
Human papillomavirus 18
Papillomavirus Infections
Outcome Assessment (Health Care)
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Short term persistence of human papillomavirus and risk of cervical precancer and cancer : Population based cohort study. / Castle, Philip E.; Rodríguez, Ana Cecilia; Burk, Robert D.; Herrero, Rolando; Wacholder, Sholom; Alfaro, Mario; Morales, Jorge; Guillen, Diego; Sherman, Mark E.; Solomon, Diane; Schiffman, Mark.

In: BMJ (Online), Vol. 339, No. 7716, 08.08.2009, p. 327.

Research output: Contribution to journalArticle

Castle, PE, Rodríguez, AC, Burk, RD, Herrero, R, Wacholder, S, Alfaro, M, Morales, J, Guillen, D, Sherman, ME, Solomon, D & Schiffman, M 2009, 'Short term persistence of human papillomavirus and risk of cervical precancer and cancer: Population based cohort study', BMJ (Online), vol. 339, no. 7716, pp. 327. https://doi.org/10.1136/bmj.b2569
Castle, Philip E. ; Rodríguez, Ana Cecilia ; Burk, Robert D. ; Herrero, Rolando ; Wacholder, Sholom ; Alfaro, Mario ; Morales, Jorge ; Guillen, Diego ; Sherman, Mark E. ; Solomon, Diane ; Schiffman, Mark. / Short term persistence of human papillomavirus and risk of cervical precancer and cancer : Population based cohort study. In: BMJ (Online). 2009 ; Vol. 339, No. 7716. pp. 327.
@article{cd7e93932eea4ed6bb3a058e06325317,
title = "Short term persistence of human papillomavirus and risk of cervical precancer and cancer: Population based cohort study",
abstract = "Objective: To evaluate the cumulative incidence of cervical intraepithelial neoplasia II or worse (grade II+) or cervical intraepithelial neoplasia grade III+ after short term persistence of prevalently detected carcinogenic human papillomavirus (HPV). Design: Population based cohort study. Setting: Guanacaste, Costa Rica. Participants: 2282 sexually active women actively followed after enrolment. Main outcome measures: Primary end points: three year and five year cumulative incidence of histologically confirmed cervical intraepithelial neoplasia grade II+ (n=70). Cervical specimens collected at each visit tested for more than 40 HPV genotypes. HPV 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, and 82 were considered the primary carcinogenic genotypes. Results: Women who tested positive for a carcinogenic HPV at enrolment and after about one year (9-21 months) (positive/positive) had a three year cumulative incidence of cervical intraepithelial neoplasia grade II+ of 17.0{\%} (95{\%} confidence interval 12.1{\%} to 22.0{\%}). Those who tested negative/positive (3.4{\%}, 0.1{\%} to 6.8{\%}), positive/negative (1.2{\%}, -0.2{\%} to 2.5{\%}), and negative/negative (0.5{\%}, 0.1{\%} to 0.9{\%}) were at a significantly lower risk. There was little difference in the cumulative incidence of cervical intraepithelial neoplasia grade II+ between testing positive twice for any carcinogenic HPV genotype (same genotype or different genotypes) v testing positive twice for the same carcinogenic genotype (17.0{\%} v 21.3{\%}, respectively). Short term persistence of HPV 16 strongly predicted cervical intraepithelial neoplasia grade II+, with a three year cumulative incidence of 40.8{\%} (26.4{\%} to 55.1{\%}). Similar patterns were observed for the five year cumulative incidence of grade II+ and for three year and five year cumulative incidence of grade III+. Conclusions: Short term persistence of a prevalently detected carcinogenic HPV infection, especially HPV 16, strongly predicts a subsequent diagnosis of cervical intraepithelial neoplasia II+ over the next few years.",
author = "Castle, {Philip E.} and Rodr{\'i}guez, {Ana Cecilia} and Burk, {Robert D.} and Rolando Herrero and Sholom Wacholder and Mario Alfaro and Jorge Morales and Diego Guillen and Sherman, {Mark E.} and Diane Solomon and Mark Schiffman",
year = "2009",
month = "8",
day = "8",
doi = "10.1136/bmj.b2569",
language = "English (US)",
volume = "339",
pages = "327",
journal = "BMJ (Online)",
issn = "0959-8146",
publisher = "BMJ Publishing Group",
number = "7716",

}

TY - JOUR

T1 - Short term persistence of human papillomavirus and risk of cervical precancer and cancer

T2 - Population based cohort study

AU - Castle, Philip E.

AU - Rodríguez, Ana Cecilia

AU - Burk, Robert D.

AU - Herrero, Rolando

AU - Wacholder, Sholom

AU - Alfaro, Mario

AU - Morales, Jorge

AU - Guillen, Diego

AU - Sherman, Mark E.

AU - Solomon, Diane

AU - Schiffman, Mark

PY - 2009/8/8

Y1 - 2009/8/8

N2 - Objective: To evaluate the cumulative incidence of cervical intraepithelial neoplasia II or worse (grade II+) or cervical intraepithelial neoplasia grade III+ after short term persistence of prevalently detected carcinogenic human papillomavirus (HPV). Design: Population based cohort study. Setting: Guanacaste, Costa Rica. Participants: 2282 sexually active women actively followed after enrolment. Main outcome measures: Primary end points: three year and five year cumulative incidence of histologically confirmed cervical intraepithelial neoplasia grade II+ (n=70). Cervical specimens collected at each visit tested for more than 40 HPV genotypes. HPV 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, and 82 were considered the primary carcinogenic genotypes. Results: Women who tested positive for a carcinogenic HPV at enrolment and after about one year (9-21 months) (positive/positive) had a three year cumulative incidence of cervical intraepithelial neoplasia grade II+ of 17.0% (95% confidence interval 12.1% to 22.0%). Those who tested negative/positive (3.4%, 0.1% to 6.8%), positive/negative (1.2%, -0.2% to 2.5%), and negative/negative (0.5%, 0.1% to 0.9%) were at a significantly lower risk. There was little difference in the cumulative incidence of cervical intraepithelial neoplasia grade II+ between testing positive twice for any carcinogenic HPV genotype (same genotype or different genotypes) v testing positive twice for the same carcinogenic genotype (17.0% v 21.3%, respectively). Short term persistence of HPV 16 strongly predicted cervical intraepithelial neoplasia grade II+, with a three year cumulative incidence of 40.8% (26.4% to 55.1%). Similar patterns were observed for the five year cumulative incidence of grade II+ and for three year and five year cumulative incidence of grade III+. Conclusions: Short term persistence of a prevalently detected carcinogenic HPV infection, especially HPV 16, strongly predicts a subsequent diagnosis of cervical intraepithelial neoplasia II+ over the next few years.

AB - Objective: To evaluate the cumulative incidence of cervical intraepithelial neoplasia II or worse (grade II+) or cervical intraepithelial neoplasia grade III+ after short term persistence of prevalently detected carcinogenic human papillomavirus (HPV). Design: Population based cohort study. Setting: Guanacaste, Costa Rica. Participants: 2282 sexually active women actively followed after enrolment. Main outcome measures: Primary end points: three year and five year cumulative incidence of histologically confirmed cervical intraepithelial neoplasia grade II+ (n=70). Cervical specimens collected at each visit tested for more than 40 HPV genotypes. HPV 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, and 82 were considered the primary carcinogenic genotypes. Results: Women who tested positive for a carcinogenic HPV at enrolment and after about one year (9-21 months) (positive/positive) had a three year cumulative incidence of cervical intraepithelial neoplasia grade II+ of 17.0% (95% confidence interval 12.1% to 22.0%). Those who tested negative/positive (3.4%, 0.1% to 6.8%), positive/negative (1.2%, -0.2% to 2.5%), and negative/negative (0.5%, 0.1% to 0.9%) were at a significantly lower risk. There was little difference in the cumulative incidence of cervical intraepithelial neoplasia grade II+ between testing positive twice for any carcinogenic HPV genotype (same genotype or different genotypes) v testing positive twice for the same carcinogenic genotype (17.0% v 21.3%, respectively). Short term persistence of HPV 16 strongly predicted cervical intraepithelial neoplasia grade II+, with a three year cumulative incidence of 40.8% (26.4% to 55.1%). Similar patterns were observed for the five year cumulative incidence of grade II+ and for three year and five year cumulative incidence of grade III+. Conclusions: Short term persistence of a prevalently detected carcinogenic HPV infection, especially HPV 16, strongly predicts a subsequent diagnosis of cervical intraepithelial neoplasia II+ over the next few years.

UR - http://www.scopus.com/inward/record.url?scp=69449084161&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=69449084161&partnerID=8YFLogxK

U2 - 10.1136/bmj.b2569

DO - 10.1136/bmj.b2569

M3 - Article

C2 - 19638649

AN - SCOPUS:69449084161

VL - 339

SP - 327

JO - BMJ (Online)

JF - BMJ (Online)

SN - 0959-8146

IS - 7716

ER -