Subsequent risk and presentation of cervical intraepithelial neoplasia (CIN) 3 or cancer after a colposcopic diagnosis of CIN 1 or less

Pretorius, Robert G.; Peterson, Pat; Azizi, Faramarz; Burchette, Raoul J.

doi:10.1016/j.ajog.2006.07.036

Cited by 57 publications

(21 citation statements)

References 20 publications

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“…33 It is reasonable to suggest that at least one biopsy should be systematically collected from the most suspicious area of squamocolumnar junction in all hrHPV positive women triaged to colposcopy; this may substantially increase the cervical disease detection rate and would also increase the apparent PPV of an hrHPV positive test. 33,34 The costs arising from the collection of multiple biopsies can be controlled if these biopsies are included and processed in the same paraffin block. In contrast with our previous studies, the estimated adjusted PPV for detection of CIN21 was very low.…”

Section: Discussionmentioning

confidence: 99%

Specimen self‐collection and HPV DNA screening in a pilot study of 100,242 women

Lazcano‐Ponce

Lörincz

Torres

et al. 2013

Intl Journal of Cancer

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Since cervical cancer remains common in Mexico despite an established cytology screening program, the Ministry of Health recently introduced pilot front-line HPV testing into the Mexican cervical cancer screening program (CCSP). Here, we present the key field performance metrics of this population-based study. High-risk HPV DNA (hrHPV) testing was conducted on selfcollected vaginal specimens from 100,242 women aged 25-75 years residing in Morelos State. All hrHPV positive women and a random sample of 3.2% (n 5 2,864) of hrHPV negative participants were referred for colposcopic examination. The main disease endpoint of interest was cervical intraepithelial neoplasia grade 2 or higher (CIN21). We calculated relative risk, positive predictive value and negative predictive value adjusted for screening test verification bias. The overall prevalence of hrHPV was 10.8% (95%CI 10.6-11.0). Women positive for hrHPV had a relative risk of 15.7 for histologically detectable CIN21. The adjusted positive predictive value of the hrHPV test was 2.4% (95%CI 2.1-2.7); whereas the adjusted negative predictive value was 99.8% (95%CI 99.8-99.9). These findings suggest that large-scale vaginal hrHPV testing in a middle-income country can identify women at greater risk of advanced cervical abnormalities in a programmatically meaningful way but care is warranted to ensure that disease not detectable at colposcopy is kept to a minimum. PASS shows areas that need improvement and sets the stage for wider use of hrHPV screening of self-collected vaginal specimens in Mexico.High-income nations are increasingly adopting High-Risk HPV DNA (hrHPV) testing as an adjunct to primary cytology screening, since epidemiologic studies have shown that this strategy may enhance screening effectiveness.1-8 Cervical cancer remains an important problem in Mexico despite a decades-old cytology program that in 2010 screened approximately eight million women.9 Recognizing the poor effectiveness of the Mexican cytology program, the government health insurance system for low-income citizens "Seguro Popular" recently introduced an alternative cervical cancer screening program (CCSP) based on hrHPV testing for affiliated women aged 35-64 years. The goal of the new CCSP is to achieve 85% coverage of six million women over a period of 5 years.

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Section: Discussionmentioning

confidence: 99%

Specimen self‐collection and HPV DNA screening in a pilot study of 100,242 women

Lazcano‐Ponce

Lörincz

Torres

et al. 2013

Intl Journal of Cancer

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“…This is one of the first practical studies to explore the extent to which hr-HPV testing could resolve clinical follow-up management of women with abnormal Pap test and negative assessment for high-grade disease by colposcopy and biopsy (Pretorius et al , 2006; Katki et al , 2013). …”

Section: Discussionmentioning

confidence: 99%

hr-HPV testing in the follow-up of women with cytological abnormalities and negative colposcopy

et al. 2013

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Background:The follow-up after abnormal Pap smear and negative colposcopy is not clearly defined. This study aimed at investigating the role of hr-HPV testing in the management of abnormal Pap test and negative colposcopy for Cervical Intraepithelial Neoplasia grade 2 or worse (CIN2+).Methods:The study enroled 1029 women with abnormal screening cytology (years 2006–2010) and negative colposcopy for CIN2+, which subsequently performed a hr-HPV test. Incident CIN2+ lesions were identified through linkage with cancer registry, hospital discharge records, neoplastic pathology reports and the archive of screening programme (2006–2011).Results:During the follow-up, the cohort developed 133 CIN2+ lesions; only one among hr-HPV-negative women. The probability of developing CIN2+ on follow-up time was 0.44% (95% confidence interval (CI) 0.1–3.1) and 41.8% (95% CI 31.8–53.5) for hr-HPV-negative women and hr-HPV-positive women, respectively. A woman with a positive hr-HPV test had about 105 times higher probability of developing a CIN2+ lesion than a woman with a negative hr-HPV test (hazard ratio (HR)=104.5, 95% CI 14.5–755.1), adjusted for index Pap test result, age and cervix squamocolumnar junction visualisation.Conclusion:Our results confirm that hr-HPV testing is able to select the real group of women at risk of developing CIN2+ lesions in the follow-up of abnormal cytology and first negative colposcopy.

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“…While laborious, such heightened surveillance is warranted because, compared with the general population, these women remain at elevated risk of being diagnosed with subsequent CIN2+ (4-7). However, most women with a normal colposcopic impression or normal/CIN1 histology will never develop CIN2+ (6) and therefore should return to routine screening at some point.…”

Section: Introductionmentioning

confidence: 99%

Follow-up Testing After Colposcopy

Katki

Gage

Schiffman

et al. 2013

Journal of Lower Genital Tract Disease

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Objective The majority of women referred for colposcopy are not diagnosed with CIN2+ but, nonetheless, are typically asked to return much sooner than their next routine screening interval in 3-5 years. An important question is how many subsequent negative Pap results, or negative Pap and HPV cotest results, are needed prior to returning to an extended retesting interval. Methods We estimated 5-year risks of CIN2+ for 3 follow-up management strategies after colposcopy (Pap-alone, HPV-alone and cotesting) for 20,319 women aged 25 and older screened from 2003-2010 at Kaiser Permanente Northern California who were referred for colposcopy but for whom CIN2+ was not initially diagnosed (i.e., “Women with CIN1/negative colposcopy”). Results Screening results immediately antecedent to CIN1/negative colposcopy influenced subsequent 5-year CIN2+ risk: women with an antecedent HPV-positive/ASC-US or LSIL Pap had a lower risk (10%) than those with antecedent ASC-H (16%, p<0.0001) or HSIL+ (24%, p<0.0001). For women with an antecedent HPV-positive/ASC-US or LSIL, a single negative cotest approximately 1 year post-colposcopy predicted lower subsequent 5-year risk of CIN2+ (1.1%) than 2 sequential negative HPV tests (1.8%, p=0.3) or 2 sequential negative Pap results (4.0%, p<0.0001). For those with an antecedent ASC-H or HSIL+ Pap, 1 negative cotest after 1 year predicted lower subsequent 5-year risk of CIN2+ (2.2%) than 1 negative HPV test (4.4%, p=0.4) or 1 negative Pap (7.0%, p=0.06); insufficient data existed to calculate risk after sequential negative cotests for women with high grade antecedent cytology. Conclusions After CIN1/negative colposcopy followed by negative post-colposcopy tests, women did not achieve sufficiently low CIN2+ risk to return to 5-year routine screening. For women with antecedent HPV-positive/ASC-US or LSIL, a single negative post-colposcopy cotest reduced risk to a level consistent with a 3-year return. For women with antecedent ASC-H or HSIL+, no single negative test result sufficed to reduce risk to a level consistent with a 3-year return. Precis For women with CIN1/negative colposcopy and antecedent HPV-positive/ASC-US or LSIL, a single negative post-colposcopy cotest reduced risk to a level consistent with a 3-year return.

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Subsequent risk and presentation of cervical intraepithelial neoplasia (CIN) 3 or cancer after a colposcopic diagnosis of CIN 1 or less

Cited by 57 publications

References 20 publications

Specimen self‐collection and HPV DNA screening in a pilot study of 100,242 women

Specimen self‐collection and HPV DNA screening in a pilot study of 100,242 women

hr-HPV testing in the follow-up of women with cytological abnormalities and negative colposcopy

Follow-up Testing After Colposcopy

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