BACKGROUND: Cervical cancer is caused by persistent human papillomavirus (HPV) infection. US consensus management guidelines for a positive cervical screening result typically focus on the current screening result only. A negative testing history may alter risk of the following positive screening results, caused by a new HPV infection, and therefore its optimal management. METHODS: Women ages 30 years and older were screened with triennial HPV and cytology co-testing at Kaiser Permanente Northern California from 2003 to 2014. We estimated the subsequent 5-year risks of cervical intraepithelial neoplasia grade 3 or more severe diagnoses (CIN3+) in a cohort of 1 156 387 women following abnormal (atypical squamous cells of undetermined significance [ASC-US] or worse) cytology and/or positive HPV testing, when the test result followed 0 (n = 990 013), 1 (n = 543 986), 2 (n = 245 974), or 3 (n = 79 946) consecutive negative co-test(s). All statistical tests were two-sided. RESULTS: Following 0-3 successive negative co-tests, 5-year CIN3+ risks following a positive HPV test decreased progressively from 7.2% (95% CI = 7.0% to 7.4%) to 1.5% (95% CI = 0.7% to 3.4%) (Ptrend < .001). Similarly, risks following an abnormal (ASC-US or worse) cytology result decreased from 6.6% (95% CI = 6.4% to 6.9%) to 1.1% (95% CI = 0.5% to 2.3%) (Ptrend < .001). Risks following low-grade squamous intraepithelial lesion, the risk threshold for referral to colposcopy in the United States, decreased from 5.2% (95% CI = 4.7% to 5.7%) to 0.9% (95% CI = 0.2% to 4.3%). Risks following high-grade squamous intraepithelial lesion or more severe, a specific marker for the presence of precancerous lesions, decreased from 50.0% (95% CI = 47.5% to 52.5%) to 10.0% (95% CI = 2.6% to 34.4%). CONCLUSIONS: Following one or more sequential antecedent, documented negative co-tests or HPV tests, women with HPV-positive ASC-US or low-grade squamous intraepithelial lesion might have sufficiently low CIN3+ risk that they do not need colposcopy referral and might instead undergo 6-12-month surveillance for evidence of higher risk before being referred to colposcopy.
BACKGROUND: Cervical cancer is caused by persistent human papillomavirus (HPV) infection. US consensus management guidelines for a positive cervical screening result typically focus on the current screening result only. A negative testing history may alter risk of the following positive screening results, caused by a new HPV infection, and therefore its optimal management. METHODS:Women ages 30 years and older were screened with triennial HPV and cytology co-testing at Kaiser Permanente Northern California from 2003 to 2014. We estimated the subsequent 5-year risks of cervical intraepithelial neoplasia grade 3 or more severe diagnoses (CIN3+) in a cohort of 1 156 387 women following abnormal (atypical squamous cells of undetermined significance [ASC-US] or worse) cytology and/or positive HPV testing, when the test result followed 0 (n = 990 013), 1 (n = 543 986), 2 (n = 245 974), or 3 (n = 79 946) consecutive negative co-test(s). All statistical tests were two-sided. RESULTS: Following 0-3 successive negative co-tests, 5-year CIN3+ risks following a positive HPV test decreased progressively from 7.2% (95% CI = 7.0% to 7.4%) to 1.5% (95% CI = 0.7% to 3.4%) (Ptrend < .001). Similarly, risks following an abnormal (ASC-US or worse) cytology result decreased from 6.6% (95% CI = 6.4% to 6.9%) to 1.1% (95% CI = 0.5% to 2.3%) (Ptrend < .001). Risks following low-grade squamous intraepithelial lesion, the risk threshold for referral to colposcopy in the United States, decreased from 5.2% (95% CI = 4.7% to 5.7%) to 0.9% (95% CI = 0.2% to 4.3%). Risks following high-grade squamous intraepithelial lesion or more severe, a specific marker for the presence of precancerous lesions, decreased from 50.0% (95% CI = 47.5% to 52.5%) to 10.0% (95% CI = 2.6% to 34.4%). CONCLUSIONS: Following one or more sequential antecedent, documented negative co-tests or HPV tests, women with HPV-positive ASC-US or low-grade squamous intraepithelial lesion might have sufficiently low CIN3+ risk that they do not need colposcopy referral and might instead undergo 6-12-month surveillance for evidence of higher risk before being referred to colposcopy.
Authors: Warner K Huh; Kevin A Ault; David Chelmow; Diane D Davey; Robert A Goulart; Francisco A R Garcia; Walter K Kinney; L Stewart Massad; Edward J Mayeaux; Debbie Saslow; Mark Schiffman; Nicolas Wentzensen; Herschel W Lawson; Mark H Einstein Journal: Gynecol Oncol Date: 2015-01-08 Impact factor: 5.482
Authors: Debbie Saslow; Diane Solomon; Herschel W Lawson; Maureen Killackey; Shalini L Kulasingam; Joanna Cain; Francisco A R Garcia; Ann T Moriarty; Alan G Waxman; David C Wilbur; Nicolas Wentzensen; Levi S Downs; Mark Spitzer; Anna-Barbara Moscicki; Eduardo L Franco; Mark H Stoler; Mark Schiffman; Philip E Castle; Evan R Myers Journal: CA Cancer J Clin Date: 2012-03-14 Impact factor: 508.702
Authors: Julia C Gage; William C Hunt; Mark Schiffman; Hormuzd A Katki; Li C Cheung; Jack Cuzick; Orrin Myers; Philip E Castle; Cosette M Wheeler Journal: Cancer Epidemiol Biomarkers Prev Date: 2015-10-30 Impact factor: 4.254
Authors: Mark Schiffman; Nicolas Wentzensen; Michelle J Khan; Philip E Castle; David Chelmow; Warner K Huh; Anna Barbara Moscicki; Colleen K Stockdale; Teresa M Darragh; Michelle Silver; Richard S Guido Journal: J Low Genit Tract Dis Date: 2017-04 Impact factor: 1.925
Authors: Julia C Gage; Mark Schiffman; Hormuzd A Katki; Philip E Castle; Barbara Fetterman; Nicolas Wentzensen; Nancy E Poitras; Thomas Lorey; Li C Cheung; Walter K Kinney Journal: J Natl Cancer Inst Date: 2014-07-18 Impact factor: 13.506
Authors: Henry C Kitchener; Clare Gilham; Alexandra Sargent; Andrew Bailey; Rebecca Albrow; Christopher Roberts; Mina Desai; Jean Mather; Andrew Turner; Sue Moss; Julian Peto Journal: Eur J Cancer Date: 2011-02-18 Impact factor: 9.162
Authors: M Zorzi; H Frayle; M Rizzi; C Fedato; M Rugge; M G Penon; A Bertazzo; S Callegaro; M Campagnolo; F Ortu; A Del Mistro Journal: BJOG Date: 2017-04-12 Impact factor: 6.531
Authors: Maria Demarco; Didem Egemen; Noorie Hyun; Xiaojian Chen; Anna-Barbara Moscicki; Li Cheung; Olivia Carter-Pokras; Anne Hammer; Julia C Gage; Megan A Clarke; Philip E Castle; Brian Befano; Jie Chen; Cher Dallal; Xin He; Kanan Desai; Thomas Lorey; Nancy Poitras; Tina R Raine-Bennett; Rebecca B Perkins; Nicolas Wentzensen; Mark Schiffman Journal: J Low Genit Tract Dis Date: 2022-04-01 Impact factor: 3.842
Authors: Julia C Gage; Tina Raine-Bennett; Mark Schiffman; Megan A Clarke; Li C Cheung; Nancy E Poitras; Nicole E Varnado; Hormuzd A Katki; Philip E Castle; Brian Befano; Malini Chandra; Greg Rydzak; Thomas Lorey; Nicolas Wentzensen Journal: Cancer Epidemiol Biomarkers Prev Date: 2021-11-17 Impact factor: 4.090
Authors: Anna Gottschlich; Dirk van Niekerk; Laurie W Smith; Lovedeep Gondara; Joy Melnikow; Darrel A Cook; Marette Lee; Gavin Stuart; Ruth E Martin; Stuart Peacock; Eduardo L Franco; Andrew Coldman; Mel Krajden; Gina Ogilvie Journal: Cancer Epidemiol Biomarkers Prev Date: 2020-10-20 Impact factor: 4.254
Authors: Clare A Aitken; Heleen M E van Agt; Albert G Siebers; Folkert J van Kemenade; Hubert G M Niesters; Willem J G Melchers; Judith E M Vedder; Rob Schuurman; Adriaan J C van den Brule; Hans C van der Linden; John W J Hinrichs; Anco Molijn; Klaas J Hoogduin; Bettien M van Hemel; Inge M C M de Kok Journal: BMC Med Date: 2019-12-11 Impact factor: 8.775
Authors: Li C Cheung; Didem Egemen; Xiaojian Chen; Hormuzd A Katki; Maria Demarco; Amy L Wiser; Rebecca B Perkins; Richard S Guido; Nicolas Wentzensen; Mark Schiffman Journal: J Low Genit Tract Dis Date: 2020-04 Impact factor: 3.842