The elevated 10-Year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice

Michelle J. Khan, Philip E. Castle, Attila T. Lorincz, Sholom Wacholder, Mark S. Sherman, David R. Scott, Brenda R. Rush, Andrew G. Glass, Mark Schiffman

Research output: Contribution to journalArticle

795 Citations (Scopus)

Abstract

Background: Human papillomavirus (HPV) types 16 and 18 cause 60%-70% of cervical cancer worldwide, and other HPV types cause virtually all remaining cases. Pooled HPV testing for 13 oncogenic types, including HPV16 and 18, is currently used in clinical practice for triage of equivocal cytology and, in conjunction with Pap tests, is an option for general screening among women 30 years of age and older. It is not clear to what extent individual identification of HPV16 or HPV18 as an adjunct to pooled oncogenic HPV testing might effectively identify women at particularly high risk of cervical cancer or its immediate precursor, cervical intraepithelial neoplasia 3 (CIN3). Methods: From April 1, 1989, to November 2, 1990, a total of 20810 women in the Kaiser Permanente health plan in Portland, OR, enrolled in a cohort study of HPV and cervical neoplasia. Women were tested for 13 oncogenic HPV types by Hybrid Capture 2 (HC2), and those women with a positive HC2 test were tested for HPV16 and 18. Enrollment Pap smear interpretation and HPV test results were linked to histologically confirmed CIN3 and cervical cancer (≥CIN3) occurring during 10 years of cytologic follow-up. We calculated cumulative incidence rates with 95% confidence intervals for each interval up to 122 months using Kaplan-Meier methods. Results: The 10-year cumulative incidence rates of ≥CIN3 were 17.2% (95% confidence interval [CI] = 11.5% to 22.9%) among HPV16+ women and 13.6% (95% CI = 3.6% to 23.7%) among HPV18+ (HPV16-) women, but only 3.0% (95% CI = 1.9% to 4.2%) among HC2+ women negative for HPV16 or HPV18. The 10-year cumulative incidence among HC2- women was 0.8% (95% CI = 0.6% to 1.1%). A subanalysis among women 30 years of age and older with normal cytology at enrollment strengthened the observed risk differences. Conclusions: HPV screening that distinguishes HPV16 and HPV18 from other oncogenic HPV types may identify women at the greatest risk of ≥CIN3 and may permit less aggressive management of other women with oncogenic HPV infections.

Original languageEnglish (US)
Pages (from-to)1072-1079
Number of pages8
JournalJournal of the National Cancer Institute
Volume97
Issue number14
DOIs
StatePublished - Jul 20 2005
Externally publishedYes

Fingerprint

Human papillomavirus 18
Human papillomavirus 16
Uterine Cervical Neoplasms
Cervical Intraepithelial Neoplasia
Confidence Intervals
Papanicolaou Test
Cell Biology
Incidence
Papillomavirus Infections
Triage
Cohort Studies

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

The elevated 10-Year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. / Khan, Michelle J.; Castle, Philip E.; Lorincz, Attila T.; Wacholder, Sholom; Sherman, Mark S.; Scott, David R.; Rush, Brenda R.; Glass, Andrew G.; Schiffman, Mark.

In: Journal of the National Cancer Institute, Vol. 97, No. 14, 20.07.2005, p. 1072-1079.

Research output: Contribution to journalArticle

Khan, Michelle J. ; Castle, Philip E. ; Lorincz, Attila T. ; Wacholder, Sholom ; Sherman, Mark S. ; Scott, David R. ; Rush, Brenda R. ; Glass, Andrew G. ; Schiffman, Mark. / The elevated 10-Year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. In: Journal of the National Cancer Institute. 2005 ; Vol. 97, No. 14. pp. 1072-1079.
@article{067c5d47f1304361b37aca4846c34a8b,
title = "The elevated 10-Year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice",
abstract = "Background: Human papillomavirus (HPV) types 16 and 18 cause 60{\%}-70{\%} of cervical cancer worldwide, and other HPV types cause virtually all remaining cases. Pooled HPV testing for 13 oncogenic types, including HPV16 and 18, is currently used in clinical practice for triage of equivocal cytology and, in conjunction with Pap tests, is an option for general screening among women 30 years of age and older. It is not clear to what extent individual identification of HPV16 or HPV18 as an adjunct to pooled oncogenic HPV testing might effectively identify women at particularly high risk of cervical cancer or its immediate precursor, cervical intraepithelial neoplasia 3 (CIN3). Methods: From April 1, 1989, to November 2, 1990, a total of 20810 women in the Kaiser Permanente health plan in Portland, OR, enrolled in a cohort study of HPV and cervical neoplasia. Women were tested for 13 oncogenic HPV types by Hybrid Capture 2 (HC2), and those women with a positive HC2 test were tested for HPV16 and 18. Enrollment Pap smear interpretation and HPV test results were linked to histologically confirmed CIN3 and cervical cancer (≥CIN3) occurring during 10 years of cytologic follow-up. We calculated cumulative incidence rates with 95{\%} confidence intervals for each interval up to 122 months using Kaplan-Meier methods. Results: The 10-year cumulative incidence rates of ≥CIN3 were 17.2{\%} (95{\%} confidence interval [CI] = 11.5{\%} to 22.9{\%}) among HPV16+ women and 13.6{\%} (95{\%} CI = 3.6{\%} to 23.7{\%}) among HPV18+ (HPV16-) women, but only 3.0{\%} (95{\%} CI = 1.9{\%} to 4.2{\%}) among HC2+ women negative for HPV16 or HPV18. The 10-year cumulative incidence among HC2- women was 0.8{\%} (95{\%} CI = 0.6{\%} to 1.1{\%}). A subanalysis among women 30 years of age and older with normal cytology at enrollment strengthened the observed risk differences. Conclusions: HPV screening that distinguishes HPV16 and HPV18 from other oncogenic HPV types may identify women at the greatest risk of ≥CIN3 and may permit less aggressive management of other women with oncogenic HPV infections.",
author = "Khan, {Michelle J.} and Castle, {Philip E.} and Lorincz, {Attila T.} and Sholom Wacholder and Sherman, {Mark S.} and Scott, {David R.} and Rush, {Brenda R.} and Glass, {Andrew G.} and Mark Schiffman",
year = "2005",
month = "7",
day = "20",
doi = "10.1093/jnci/dji187",
language = "English (US)",
volume = "97",
pages = "1072--1079",
journal = "Journal of the National Cancer Institute",
issn = "0027-8874",
publisher = "Oxford University Press",
number = "14",

}

TY - JOUR

T1 - The elevated 10-Year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice

AU - Khan, Michelle J.

AU - Castle, Philip E.

AU - Lorincz, Attila T.

AU - Wacholder, Sholom

AU - Sherman, Mark S.

AU - Scott, David R.

AU - Rush, Brenda R.

AU - Glass, Andrew G.

AU - Schiffman, Mark

PY - 2005/7/20

Y1 - 2005/7/20

N2 - Background: Human papillomavirus (HPV) types 16 and 18 cause 60%-70% of cervical cancer worldwide, and other HPV types cause virtually all remaining cases. Pooled HPV testing for 13 oncogenic types, including HPV16 and 18, is currently used in clinical practice for triage of equivocal cytology and, in conjunction with Pap tests, is an option for general screening among women 30 years of age and older. It is not clear to what extent individual identification of HPV16 or HPV18 as an adjunct to pooled oncogenic HPV testing might effectively identify women at particularly high risk of cervical cancer or its immediate precursor, cervical intraepithelial neoplasia 3 (CIN3). Methods: From April 1, 1989, to November 2, 1990, a total of 20810 women in the Kaiser Permanente health plan in Portland, OR, enrolled in a cohort study of HPV and cervical neoplasia. Women were tested for 13 oncogenic HPV types by Hybrid Capture 2 (HC2), and those women with a positive HC2 test were tested for HPV16 and 18. Enrollment Pap smear interpretation and HPV test results were linked to histologically confirmed CIN3 and cervical cancer (≥CIN3) occurring during 10 years of cytologic follow-up. We calculated cumulative incidence rates with 95% confidence intervals for each interval up to 122 months using Kaplan-Meier methods. Results: The 10-year cumulative incidence rates of ≥CIN3 were 17.2% (95% confidence interval [CI] = 11.5% to 22.9%) among HPV16+ women and 13.6% (95% CI = 3.6% to 23.7%) among HPV18+ (HPV16-) women, but only 3.0% (95% CI = 1.9% to 4.2%) among HC2+ women negative for HPV16 or HPV18. The 10-year cumulative incidence among HC2- women was 0.8% (95% CI = 0.6% to 1.1%). A subanalysis among women 30 years of age and older with normal cytology at enrollment strengthened the observed risk differences. Conclusions: HPV screening that distinguishes HPV16 and HPV18 from other oncogenic HPV types may identify women at the greatest risk of ≥CIN3 and may permit less aggressive management of other women with oncogenic HPV infections.

AB - Background: Human papillomavirus (HPV) types 16 and 18 cause 60%-70% of cervical cancer worldwide, and other HPV types cause virtually all remaining cases. Pooled HPV testing for 13 oncogenic types, including HPV16 and 18, is currently used in clinical practice for triage of equivocal cytology and, in conjunction with Pap tests, is an option for general screening among women 30 years of age and older. It is not clear to what extent individual identification of HPV16 or HPV18 as an adjunct to pooled oncogenic HPV testing might effectively identify women at particularly high risk of cervical cancer or its immediate precursor, cervical intraepithelial neoplasia 3 (CIN3). Methods: From April 1, 1989, to November 2, 1990, a total of 20810 women in the Kaiser Permanente health plan in Portland, OR, enrolled in a cohort study of HPV and cervical neoplasia. Women were tested for 13 oncogenic HPV types by Hybrid Capture 2 (HC2), and those women with a positive HC2 test were tested for HPV16 and 18. Enrollment Pap smear interpretation and HPV test results were linked to histologically confirmed CIN3 and cervical cancer (≥CIN3) occurring during 10 years of cytologic follow-up. We calculated cumulative incidence rates with 95% confidence intervals for each interval up to 122 months using Kaplan-Meier methods. Results: The 10-year cumulative incidence rates of ≥CIN3 were 17.2% (95% confidence interval [CI] = 11.5% to 22.9%) among HPV16+ women and 13.6% (95% CI = 3.6% to 23.7%) among HPV18+ (HPV16-) women, but only 3.0% (95% CI = 1.9% to 4.2%) among HC2+ women negative for HPV16 or HPV18. The 10-year cumulative incidence among HC2- women was 0.8% (95% CI = 0.6% to 1.1%). A subanalysis among women 30 years of age and older with normal cytology at enrollment strengthened the observed risk differences. Conclusions: HPV screening that distinguishes HPV16 and HPV18 from other oncogenic HPV types may identify women at the greatest risk of ≥CIN3 and may permit less aggressive management of other women with oncogenic HPV infections.

UR - http://www.scopus.com/inward/record.url?scp=23244438005&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=23244438005&partnerID=8YFLogxK

U2 - 10.1093/jnci/dji187

DO - 10.1093/jnci/dji187

M3 - Article

C2 - 16030305

AN - SCOPUS:23244438005

VL - 97

SP - 1072

EP - 1079

JO - Journal of the National Cancer Institute

JF - Journal of the National Cancer Institute

SN - 0027-8874

IS - 14

ER -