Philip E Castle1, Mark Schiffman, Cosette M Wheeler, Diane Solomon. 1. From the Divisions of Cancer Epidemiology and Genetics and Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; and Departments of Molecular Genetics and Microbiology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, School of Medicine, Albuquerque, New Mexico.
Abstract
OBJECTIVE: To estimate the fraction of cervical intraepithelial neoplasia 2 (CIN 2) that might regress if untreated using data from the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions Triage Study (ALTS). METHODS: We compared the cumulative occurrence of CIN 2 (n=397) and CIN 3 or more severe (n=542) diagnosed by the Pathology Quality Control Group in three trial arms-immediate colposcopy, human papillomavirus (HPV) triage, and conservative management-over the 2-year duration of the ALTS trial. A nonparametric test of trend was used to test for differences in the number of CIN 2 cases relative to number of CIN 3 or more severe cases across study arms with an increasing percentage of women referred to colposcopy at baseline. RESULTS: There were no significant differences in the cumulative 2-year cumulative CIN 3 or more severe diagnoses by study arm (10.9%, conservative management; 10.3%, HPV; 10.9%, immediate colposcopy) (Ptrend=.8), but there was a significant increase in CIN 2 diagnoses (5.8%, conservative management; 7.8%, HPV triage; 9.9%, immediate colposcopy) (Ptrend<.001) in the study arms, with increasing number of women referred to colposcopy at baseline. The relative differences in cumulative CIN 2 by study arm among women who tested HPV-16 positive at baseline were less pronounced (Ptrend=.1) than women who tested positive for other high-risk-HPV genotypes (Ptrend=.01). CONCLUSION: There was evidence that approximately 40% of undiagnosed CIN 2 will regress over 2 years, but CIN 2 caused by HPV-16 may be less likely to regress than CIN 2 caused by other high-risk-HPV genotypes. LEVEL OF EVIDENCE: II.
OBJECTIVE: To estimate the fraction of cervical intraepithelial neoplasia 2 (CIN 2) that might regress if untreated using data from the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions Triage Study (ALTS). METHODS: We compared the cumulative occurrence of CIN 2 (n=397) and CIN 3 or more severe (n=542) diagnosed by the Pathology Quality Control Group in three trial arms-immediate colposcopy, human papillomavirus (HPV) triage, and conservative management-over the 2-year duration of the ALTS trial. A nonparametric test of trend was used to test for differences in the number of CIN 2 cases relative to number of CIN 3 or more severe cases across study arms with an increasing percentage of women referred to colposcopy at baseline. RESULTS: There were no significant differences in the cumulative 2-year cumulative CIN 3 or more severe diagnoses by study arm (10.9%, conservative management; 10.3%, HPV; 10.9%, immediate colposcopy) (Ptrend=.8), but there was a significant increase in CIN 2 diagnoses (5.8%, conservative management; 7.8%, HPV triage; 9.9%, immediate colposcopy) (Ptrend<.001) in the study arms, with increasing number of women referred to colposcopy at baseline. The relative differences in cumulative CIN 2 by study arm among women who tested HPV-16 positive at baseline were less pronounced (Ptrend=.1) than women who tested positive for other high-risk-HPV genotypes (Ptrend=.01). CONCLUSION: There was evidence that approximately 40% of undiagnosed CIN 2 will regress over 2 years, but CIN 2 caused by HPV-16 may be less likely to regress than CIN 2 caused by other high-risk-HPV genotypes. LEVEL OF EVIDENCE: II.
Authors: P E Gravitt; C L Peyton; T Q Alessi; C M Wheeler; F Coutlée; A Hildesheim; M H Schiffman; D R Scott; R J Apple Journal: J Clin Microbiol Date: 2000-01 Impact factor: 5.948
Authors: Qi Zhang; Louise Kuhn; Lynette A Denny; Michelle De Souza; Sylvia Taylor; Thomas C Wright Journal: Int J Cancer Date: 2007-01-15 Impact factor: 7.396
Authors: R Klaes; T Friedrich; D Spitkovsky; R Ridder; W Rudy; U Petry; G Dallenbach-Hellweg; D Schmidt; M von Knebel Doeberitz Journal: Int J Cancer Date: 2001-04-15 Impact factor: 7.396
Authors: K A Keefe; M J Schell; C Brewer; M McHale; W Brewster; J A Chapman; G S Rose; D S McMeeken; W Lagerberg; Y M Peng; S P Wilczynski; H Anton-Culver; F L Meyskens; M L Berman Journal: Cancer Epidemiol Biomarkers Prev Date: 2001-10 Impact factor: 4.254
Authors: Philip E Castle; Diane Solomon; Cosette M Wheeler; Patti E Gravitt; Sholom Wacholder; Mark Schiffman Journal: J Clin Microbiol Date: 2008-06-25 Impact factor: 5.948
Authors: Joseph D Carreon; Mark E Sherman; Diego Guillén; Diane Solomon; Rolando Herrero; Jose Jerónimo; Sholom Wacholder; Ana Cecilia Rodríguez; Jorge Morales; Martha Hutchinson; Robert D Burk; Mark Schiffman Journal: Int J Gynecol Pathol Date: 2007-10 Impact factor: 2.762
Authors: Thomas C Wright; L Stewart Massad; Charles J Dunton; Mark Spitzer; Edward J Wilkinson; Diane Solomon Journal: Am J Obstet Gynecol Date: 2007-10 Impact factor: 8.661
Authors: Fang-Hui Zhao; Margaret Jane Lin; Feng Chen; Shang-Ying Hu; Rong Zhang; Jerome L Belinson; John W Sellors; Silvia Franceschi; You-Lin Qiao; Philip E Castle Journal: Lancet Oncol Date: 2010-11-11 Impact factor: 41.316
Authors: Gloria Y F Ho; Mark H Einstein; Seymour L Romney; Anna S Kadish; Maria Abadi; Magdy Mikhail; Jayasri Basu; Benjamin Thysen; Laura Reimers; Prabhudas R Palan; Shelly Trim; Nafisseh Soroudi; Robert D Burk Journal: J Low Genit Tract Dis Date: 2011-10 Impact factor: 1.925
Authors: Philip E Castle; Mark Schiffman; Cosette M Wheeler; Nicolas Wentzensen; Patti E Gravitt Journal: Am J Epidemiol Date: 2009-12-10 Impact factor: 4.897