The relationship of human papillomavirus and cytology co-testing results with endometrial and ovarian cancer diagnoses

Philip E. Castle, Alexander Locke, Ana I. Tergas, Brian Befano, Nancy Poitras, Nina R. Shah, Mark Schiffman, Nicolas Wentzensen, Howard D. Strickler, Megan A. Clarke, Thomas Lorey

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: To investigate whether routine cervical screening using human papillomavirus (HPV) and cytology co-testing effectively identifies women with endometrial (EC) or ovarian (OvC) cancer. Methods: In 2003, Kaiser Permanente Northern California implemented triennial co-testing in women aged ≥30 years. Index screening results (n = 2,385,729) were linked to subsequent EC (n = 3434) and OvC (n = 1113) diagnoses from January 1, 2003 to December 31, 2017. EC were categorized as type 1 or 2, and, selectively, EC and OvC diagnoses were stratified on whether symptoms were present at the time of the co-test. Fractions and absolute risks of EC or OvC of each co-testing result were calculated. Results: Most EC (82.18%) and OvC (88.68%) were preceded by a negative HPV and negative cytology co-test. More EC were preceded by atypical squamous cells of undetermined significance (ASC-US) or more severe (ASC-US+) cytology and negative HPV test (n = 290) (8.44% of EC) compared to a negative cytology and a positive HPV test (n = 31) (0.89% of EC) (p < 0.001). The absolute risk of any EC diagnosis following ASC-US+ and negative HPV test was 0.48%. Atypical glandular cells (AGC) cytology and a negative HPV result preceded 6.92% of any EC diagnosis, with an absolute risk of 4.02%, but preceded only 1.13% of type 2 EC cases, with an absolute risk of 0.24%, in asymptomatic women. AGC cytology and a negative HPV result preceded 1.44% of OvC, with an absolute risk of 0.28%. Conclusions: Abnormal cervical screening tests, even AGC cytology, rarely precedes and poorly predict women with EC or OvC.

Original languageEnglish (US)
Pages (from-to)297-303
Number of pages7
JournalGynecologic Oncology
Volume161
Issue number1
DOIs
StatePublished - Apr 2021

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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