TY - JOUR
T1 - Similar Risk Patterns after Cervical Screening in Two Large U.S. Populations
T2 - Implications for Clinical Guidelines
AU - Gage, Julia C.
AU - Hunt, William C.
AU - Schiffman, Mark
AU - Katki, Hormuzd A.
AU - Cheung, Li A.
AU - Myers, Orrin
AU - Cuzick, Jack
AU - Wentzensen, Nicolas
AU - Kinney, Walter
AU - Castle, Philip E.
AU - Wheeler, Cosette M.
N1 - Funding Information:
Supported by U54CA164336 (to C.M. Wheeler) from the U.S. National Cancer Institute-funded Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium and in part by the Intramural Research Program of the National Cancer Institute, National Institutes of Health, Department of Health and Human Services. The overall aim of PROSPR is to conduct multisite, coordinated, transdisciplinary research to evaluate and improve cancer screening processes.
Publisher Copyright:
© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - OBJECTIVE: To compare the risks of histologic high-grade cervical intraepithelial neoplasia (CIN) or worse after different cervical cancer screening test results between two of the largest U.S. clinical practice research data sets. METHODS: The New Mexico Human Papillomavirus (HPV) Pap Registry is a statewide registry representing a diverse population experiencing varied clinical practice delivery. Kaiser Permanente Northern California is a large integrated health care delivery system practicing routine HPV cotesting since 2003. In this retrospective cohort study, a logistic-Weibull survival model was used to estimate and compare the cumulative 3- and 5-year risks of histologic CIN 3 or worse among women aged 21-64 years screened in 2007-2011 in the New Mexico HPV Pap Registry and 2003-2013 in Kaiser Permanente Northern California. Results were stratified by age and baseline screening result: negative cytology, atypical squamous cells of undetermined significance (ASC-US) (with or without HPV triage), low-grade squamous intraepithelial lesion, and high-grade squamous intraepithelial lesion. RESULTS: There were 453,618 women in the New Mexico HPV Pap Registry and 1,307,528 women at Kaiser Permanente Northern California. The 5-year CIN 3 or worse risks were similar within screening results across populations: cytology negative (0.52% and 0.30%, respectively, P<.001), HPV-negative and ASC-US (0.72% and 0.49%, respectively, P.5), ASC-US (3.4% and 3.4%, respectively, P.8), HPV-positive and ASC-US (7.7% and 7.1%, respectively, P.3), low-grade squamous intraepithelial lesion (6.5% and 5.4%, respectively, P.009), and high-grade squamous intraepithelial lesion (53.1% and 50.4%, respectively, P.2). Cervical intraepithelial neoplasia grade 2 or worse risks and 3-year risks had similar trends across populations. Age-stratified analyses showed more variability, especially among women aged younger than 30 years, but patterns of risk stratification were comparable. CONCLUSION: Current U.S. cervical screening and management recommendations are based on comparative risks of histologic high-grade CIN after screening test results. The similar results from these two large cohorts from different real-life clinical practice settings support risk-based management thresholds across U.S. clinical populations and practice settings.
AB - OBJECTIVE: To compare the risks of histologic high-grade cervical intraepithelial neoplasia (CIN) or worse after different cervical cancer screening test results between two of the largest U.S. clinical practice research data sets. METHODS: The New Mexico Human Papillomavirus (HPV) Pap Registry is a statewide registry representing a diverse population experiencing varied clinical practice delivery. Kaiser Permanente Northern California is a large integrated health care delivery system practicing routine HPV cotesting since 2003. In this retrospective cohort study, a logistic-Weibull survival model was used to estimate and compare the cumulative 3- and 5-year risks of histologic CIN 3 or worse among women aged 21-64 years screened in 2007-2011 in the New Mexico HPV Pap Registry and 2003-2013 in Kaiser Permanente Northern California. Results were stratified by age and baseline screening result: negative cytology, atypical squamous cells of undetermined significance (ASC-US) (with or without HPV triage), low-grade squamous intraepithelial lesion, and high-grade squamous intraepithelial lesion. RESULTS: There were 453,618 women in the New Mexico HPV Pap Registry and 1,307,528 women at Kaiser Permanente Northern California. The 5-year CIN 3 or worse risks were similar within screening results across populations: cytology negative (0.52% and 0.30%, respectively, P<.001), HPV-negative and ASC-US (0.72% and 0.49%, respectively, P.5), ASC-US (3.4% and 3.4%, respectively, P.8), HPV-positive and ASC-US (7.7% and 7.1%, respectively, P.3), low-grade squamous intraepithelial lesion (6.5% and 5.4%, respectively, P.009), and high-grade squamous intraepithelial lesion (53.1% and 50.4%, respectively, P.2). Cervical intraepithelial neoplasia grade 2 or worse risks and 3-year risks had similar trends across populations. Age-stratified analyses showed more variability, especially among women aged younger than 30 years, but patterns of risk stratification were comparable. CONCLUSION: Current U.S. cervical screening and management recommendations are based on comparative risks of histologic high-grade CIN after screening test results. The similar results from these two large cohorts from different real-life clinical practice settings support risk-based management thresholds across U.S. clinical populations and practice settings.
UR - http://www.scopus.com/inward/record.url?scp=84994680364&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84994680364&partnerID=8YFLogxK
U2 - 10.1097/AOG.0000000000001721
DO - 10.1097/AOG.0000000000001721
M3 - Article
C2 - 27824767
AN - SCOPUS:84994680364
SN - 0029-7844
VL - 128
SP - 1248
EP - 1257
JO - Obstetrics and Gynecology
JF - Obstetrics and Gynecology
IS - 6
ER -
