The absolute risk of cervical abnormalities in high-risk human papillomavirus-positive, cytologically normal women over a 10-year period

• Published in: Cancer research (Chicago, Ill.) Vol. 66; no. 21; pp. 10630 - 10636
• Main Authors: KJAER, Susanne, HØGDALL, Estrid, FREDERIKSEN, Kirsten, MUNK, Christian, VAN DEN BRULE, Adriaan, SVARE, Edith, MEIJER, Chris, LORINCZ, Attilla, IFTNER, Thomas
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Association for Cancer Research 01-11-2006
• Subjects: Adult; Antineoplastic agents; Biological and medical sciences; Cervical Intraepithelial Neoplasia - etiology; Female; Follow-Up Studies; Humans; Medical sciences; Middle Aged; Papanicolaou Test; Papillomaviridae - isolation & purification; Pharmacology. Drug treatments; Prospective Studies; Risk; Tumors; Uterine Cervical Neoplasms - etiology; Vaginal Smears; Human; High risk; Toxicity; Papovaviridae; Epidemiology; Infection; Papillomavirus; Virus; Human papillomavirus; Viral disease; Risk factor; Adult; Female; Woman
• ISSN: 0008-5472; 1538-7445
• DOI: 10.1158/0008-5472.can-06-1057

In spite of the success of cervical cytology as a cancer-screening tool, it has important limitations, and human papillomavirus (HPV) testing may be valuable in future screening. The majority of women in screened populations, who test HPV positive, will have a concurrent normal smear, and we need more information about the risk for subsequent high-grade cervical lesions in these women. We examined 8,656 younger women (22-32 years old) and 1,578 older women (40-50 years old) who were followed for development of cervical neoplasia (cytology and/or histology) through the Danish Pathology Data Bank. We estimated the proportion of women developing cervical lesions of different types before a given time point as a function of time. Among women with normal cytology and positive high-risk Hybrid Capture 2 (HC2) test, 17.7% and 24.5% of younger and older women, respectively, had a subsequent abnormal Pap smear within 5 years. The risk of CIN3 or cancer within 10 years among younger women with positive HC2 test was 13.6% (10.9-16.2) and 21.2% (2.7-36.1) among older women. An analysis among younger women also being HC2-positive 2 years before baseline showed a subsequent 10-year risk of > or =CIN3 of 18% (14.6-21.5). Among older women where HPV may be added to general screening, the estimated absolute risk of > or =CIN3 in HC2-positive women was more than 20% within 10 years. These results indicate that even a single positive HPV test in cytologically negative women is substantially predictive of high-grade CIN and suggest that HC2 testing can help stratify women into different risk categories.