The influence of type-specific human papillomavirus infections on the detection of cervical precancer and cancer: A population-based study of opportunistic cervical screening in the United States

Cosette M. Wheeler, William C. Hunt, Jack Cuzick, Erika Langsfeld, Michael Robertson, Philip E. Castle

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

There are limited data on the prospective risks of detecting cervical precancer and cancer in United States (US) populations specifically where the delivery of opportunistic cervical screening takes place outside managed care and in the absence of organized national programs. Such data will inform the management of women with positive screening results before and after widespread human papillomavirus (HPV) vaccination and establishes a baseline preceding recent changes in US cervical cancer screening guidelines. Using data reported to the statewide passive surveillance systems of the New Mexico HPV Pap Registry, we measured the 3-year HPV type-specific cumulative incidence of cervical intraepithelial neoplasia grade 2 or more severe (CIN2+) and grade 3 or more severe (CIN3+) detected during real-world health care delivery across a diversity of organizations, payers, clinical settings, providers and patients. A stratified sample of 47,541 cervical cytology specimens from a screening population of 379,000 women underwent HPV genotyping. Three-year risks for different combinations of cytologic interpretation and HPV risk group ranged from <1% (for several combinations) to approximately 70% for CIN2+ and 55% for CIN3+ in women with high-grade (HSIL) cytology and HPV16 infection. A substantial proportion of CIN2+ (35.7%) and CIN3+ (30.9%) were diagnosed following negative cytology, of which 62.3 and 78.2%, respectively, were high-risk HPV positive. HPV16 had the greatest 3-year risks (10.9% for CIN2+,8.0% for CIN3+) followed by HPV33, HPV31, and HPV18. Positive results for high-risk HPV, especially HPV16, the severity of cytologic interpretation, and age contribute independently to the risks of CIN2+ and CIN3+. What's new? Age, cytologic diagnosis, and human papillomavirus (HPV) genotype are key factors in deciding how cervical precancer and cancer patients should be managed, but few studies have had sufficient case numbers to examine interplay among these factors. In this study, age, cytologic diagnosis, and HPV genotype were found to contribute independently to disease detection. A substantial proportion of disease occurred when women were cytology negative but high-risk HPV-positive. The data provide baseline measurements to judge HPV vaccination and cervical screening effectiveness in U.S. populations, where these interventions are delivered opportunistically.

Original languageEnglish (US)
Pages (from-to)624-634
Number of pages11
JournalInternational Journal of Cancer
Volume135
Issue number3
DOIs
StatePublished - Aug 1 2014
Externally publishedYes

Keywords

  • Cervical cancer
  • Cervical intraepithelial neoplasia (CIN)
  • Cervical screening effectiveness
  • Cytology
  • HPV vaccine effectiveness
  • Human papillomavirus (HPV)
  • Pap test
  • US opportunistic cervical screening

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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