Cervical Neoplasia in Pap Smears: Risk of Cervical Intra-Epithelial Neoplasia (CIN) after Negative or No Prior Smears in a Population without a Mass Screening Programme

Forsmo, Siri; Jacobsen, Bjarne K.; Stalsberg, Helge

doi:10.1093/ije/25.1.53

Cited by 14 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The CIN3 rate at entry in women with no previous smear history was similar to that in the screened population both in our cohort (Table 1) and in a Norwegian study (Forsmo et al, 1996), and the rate at their second smear was slightly less than in previously screened women (Table 4). A much lower CIN3 rate was observed at the second smear than at entry in a national study of inadequately screened low-income American women (Sawaya et al, 2003), but this may reflect confounding between screening interval and number of negative smears.…”

Section: Cytological Regression Of Cin3supporting

confidence: 82%

Cervical HPV infection and neoplasia in a large population-based prospective study: the Manchester cohort

et al. 2004

View full text Add to dashboard Cite

Cytology and histology records and cervical samples for HPV assay were obtained from a prospective cohort of 49 655 women attending clinics for routine cervical cytology in or near Manchester between 1988 and 1993. The women were followed up for cytological abnormality and neoplasia through the cytology laboratory's records. HPV at entry was assayed in an age-and periodstratified random sample of 7278 women and in prevalent and incident CIN3 cases. The prevalence of newly diagnosed CIN3 increased with time since last normal smear, indicating that most cases persist for several years. CIN3 prevalence did not increase further for screening intervals exceeding 5 years, however, suggesting that CIN3 eventually regresses cytologically. CIN2 prevalence increased less steeply with screening interval, while the prevalence of lesser abnormality was almost independent of screening interval. The prevalence of oncogenic HPV at entry declined from 19% among women aged under 25 to less than 3% at age 40 or above. Oncogenic HPV infection was strongly predictive of subsequent CIN3 (OR 17.2, 95% CI 10.4 -28.4), but only weakly related to CIN2 (OR 2.3, 95% CI 0.5 -10.7) and lesser abnormality (OR 1.4, 95% CI 0.8 -2.5). At current incidence rates, the lifetime risk of developing CIN3 will be 9% in this population. The cumulative risk of CIN3 diagnosis among cytologically normal women with oncogenic HPV detected at entry was 28% (CI 18 -43%) after 14 years. Persistence of oncogenic HPV may be more sensitive and specific than cytology for early detection of CIN3 and invasive cancer. Population-based prospective data on cervical neoplasia rates in relation to age, screening interval and history of type-specific HPV infection are still limited. Few cohorts are representative of regularly screened women in the general population, and those using the Bethesda system under which the high-grade category (HSIL) includes both CIN2 and CIN3 (Solomon et al, 2002) have often not analysed CIN2 and CIN3 separately. There is a strong and consistent association of genital HPV infection with cervical intraepithelial neoplasia (CIN) and cancer. CIN3 is almost always preceded by persistently detectable oncogenic HPV (Nobbenhuis et al, 1999), and HPV DNA was present in virtually all (99.7%) of a large sample of cervical cancers obtained from populations worldwide . Uninfected women, including those with abnormal cytology, are thus at negligible risk of invasive cancer. Follow-up studies indicate that most HPV infections are transient (Hildesheim et al, 1994;Remmink et al, 1995;Ho et al, 1998;Liaw et al, 1999;Nobbenhuis et al, 1999), but women with persistent HPV are at high risk of developing CIN3 (Nobbenhuis et al, 1999(Nobbenhuis et al, , 2001. HPV testing could thus be superior to cytology in routine cervical screening (Nobbenhuis et al, 1999;Cuzick et al, 2003).This report describes the relationship between HPV detection at entry and cytological and histological follow-up based on routine laboratory records in a prospective population-based cohort...

show abstract

Section: Cytological Regression Of Cin3supporting

confidence: 82%

Cervical HPV infection and neoplasia in a large population-based prospective study: the Manchester cohort

et al. 2004

View full text Add to dashboard Cite

show abstract

“…However, the finding that women with lesions progressing to tissue-proven CIN 3 were younger at CIN debut than those with regressing lesions is in keeping with earlier reports [5,17,18,21]. It fits in with the fact that CIN 1-2 has maximum frequency among women in their twenties, while CIN 3 peaks in those aged 35-39 years [6,7]. This would be compatible with a stepwise development of CIN.…”

Section: Discussionsupporting

confidence: 90%

“…These lesions often run a fluctuating course and may even regress [4,5]. While it is widely accepted that women in their twenties are at high risk of developing CIN [6,7], the situation in women who have provided a series of negative smears and thus represent an older age group, has received less attention. These women have increased relative protection against cervical cancer [8].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Implications of Cervical Intraepithelial Neoplasia in a Single Cervical Smear

Bertelsen

Hartveit²

1998

Gynecol Obstet Invest

View full text Add to dashboard Cite

Our aim was to investigate the prognostic implications of a single cervical smear showing cervical intraepithelial neoplasia (CIN) in a group of women with a previous series of negative smears, and to estimate their risk of developing histologically confirmed CIN 3. A retrospective case-control study was set up. It consisted of 171 cases and 513 age-matched controls, all with at least 3 negative and no positive smears between 1981 and 1988 inclusive. In all cases CIN had been diagnosed on cytology in 1989, while the controls had remained negative. The women were followed up to the end of 1995. The outcome was recorded in terms of regression, progression, persistence or surgical treatment. In women with a single smear showing CIN 1 or 2, the risk of developing histologically proven CIN 3 was 14 and 26 times that in women with negative smears. Negative control smears in the short term did not exclude subsequent progression. Thus women with a single cervical smear indicating CIN 1 had a greatly enhanced risk of producing a lesion that demanded intervention. Such cases should be observed closely with repeat smears over a period of at least 6 years.

show abstract

“…The results on smear history were unrepresentative, as the majority of this birth cohort had not accumulated three consecutive regular smears. An audit of the screened population in the UK found that only 21% of women aged 50 would be eligible for early withdrawal on the basis of an adequate smear history (15) . This reflects the comparatively recent introduction of systematic call/recall in the UK since 1988.…”

Section: Discussionmentioning

confidence: 99%

Age-restricted cervical screening: HPV testing at age 50 identifies a high risk group for cervical disease

Cruickshank

Chambers

Murray

et al. 2002

Int J Gynecol Cancer

View full text Add to dashboard Cite

Changes to the present age policy of cervical screening are currently under consideration. We conducted a retrospective matched case-control study and cost analysis study to identify risk factors for the development of an abnormal smear after age 50 and to determine the impact of age-restricted cervical screening on the annual cost of the screening program. All women (229) from an 11-year birth cohort who developed an abnormal smear at age 50 or over were age-matched for two controls with negative smears. Routine screening smears taken between age 48 and 52 were tested for human papillomavirus (HPV) subtypes 16 and 18. Epidemiologic data were collected by postal questionnaire. Changes in costs under a policy of HPV testing and age-restricted screening were assessed. We found that HPV 16 status was the only independently significant risk factor for abnormal cytology after age 50 with an odds ratio of 10.26 (95% CI 1.25-84.11). A policy of early withdrawal from screening at age 50 on the basis of HPV testing would produce net cost savings. These findings suggest that HPV testing could be a valuable means of identifying the small proportion of women still at risk after 50, and of releasing health care resources.

show abstract

Cervical Neoplasia in Pap Smears: Risk of Cervical Intra-Epithelial Neoplasia (CIN) after Negative or No Prior Smears in a Population without a Mass Screening Programme

Cited by 14 publications

References 16 publications

Cervical HPV infection and neoplasia in a large population-based prospective study: the Manchester cohort

Cervical HPV infection and neoplasia in a large population-based prospective study: the Manchester cohort

Prognostic Implications of Cervical Intraepithelial Neoplasia in a Single Cervical Smear

Age-restricted cervical screening: HPV testing at age 50 identifies a high risk group for cervical disease

Contact Info

Product

Resources

About