Relation of human papilloma virus status to cervical lesions and consequences for cervical-cancer screening: a prospective study

Nobbenhuis, Mariëlle; Walboomers, Jan M. M.; Helmerhorst, Theo J.M.; Rozendaal, Lawrence; Remmink, Ans J.; Risse, Elle K.J.; Linden, Hans van der; Voorhorst, Feja J.; Kenemans, P.; Meijer, Chris J.L.M.

doi:10.1016/s0140-6736(98)12490-x

Cited by 638 publications

(459 citation statements)

References 23 publications

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“…For contrasts we used the log-rank test. The time-point of HPV clearance was taken at the mid-point between positive and negative test results for high-risk HPV (Nobbenhuis et al, 1999(Nobbenhuis et al, , 2001. We included 179 non-pregnant women with a high-risk HPV positive test at baseline (Figure 1; group A) and 38 women with a high-risk HPV positive test at their first visit during pregnancy (Figure 1; groups B and C).…”

Section: Discussionmentioning

confidence: 99%

“…The characteristics of this cohort have been described previously (Nobbenhuis et al, 1999(Nobbenhuis et al, , 2001. Briefly, the inclusion criteria were: referral because of an abnormal cervical smear (i.e.…”

Section: Womenmentioning

confidence: 99%

“…Women were monitored every 3 to 4 months by cytology, colposcopy and HPV testing (Remmink et al, 1995;Nobbenhuis et al, 1999Nobbenhuis et al, , 2001. Clinicians and laboratory staff were blinded for HPV test results and clinical findings, respectively.…”

Section: Womenmentioning

confidence: 99%

“…Women were considered to be clear of infection when no high-risk HPV type from the previous visit was detected at the next visit (Nobbenhuis et al, 1999(Nobbenhuis et al, , 2001). …”

Section: Definition Of Hpv Clearancementioning

confidence: 99%

“…Keywords: human papillomavirus; pregnancy; follow-up study; natural history; prevalence Several epidemiological and biological studies have established the important role of infection with high-risk types of human papilloma virus (HPV) for development of cervical cancer and its precursor lesions. In women with or without abnormal cervical smears a positive high-risk HPV test result indicates an increased risk for development of high grade cervical lesions (Ho et al, 1995;Remmink et al, 1995;Rozendaal et al, 1996Rozendaal et al, , 2000Nobbenhuis et al, 1999). Moreover, in nearly all cervical cancers high-risk HPV types have been detected .…”

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High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

et al. 2002

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We followed 353 women referred with abnormal cervical cytology in a non-intervention cohort study. In 91 pregnant women we compared high-risk human papilloma virus rates in the subsequent trimesters and postpartum in comparison to 262 nonpregnant women. High-risk human papilloma virus clearance was compared with 179 high-risk human papilloma virus positive non-pregnant women. Our main questions were: (1) do high-risk human papilloma virus rates change during pregnancy?; and (2) is there any difference between high-risk human papilloma virus clearance in pregnant and non-pregnant women? Women were monitored 3 -4 monthly by cytology, colposcopy, and high-risk human papilloma virus testing. The median follow-up time was 33 months (range 3 -74). Non-pregnant women showed prevalence rates of high-risk human papilloma virus of 64, 57, 53, and 50%, respectively, in four subsequent 3-months periods since the start of the study. These high-risk human papilloma virus rates were higher than in the three trimesters of pregnancy, and during the first 3 months postpartum, i.e. 50, 44, 45, and 31%, respectively. Postpartum only, this difference was statistically significant (P=0.004). Paired comparisons of high-risk human papilloma virus prevalence rates of the different trimesters with the postpartum rate showed (McNemar test) decreased rates: first trimester: 18% (P=0.02), second trimester: 13% (P=0.02) and third trimester: 23% (P50.005). Such a phenomenon was not found in non-pregnant women. Pregnant women showed a trend for increased high-risk human papilloma virus clearance during the third trimester and postpartum compared to non-pregnant women (hazard ratios 3.3 (0.8 -13.7) and 4.6 (1.6 -12.8), respectively). These results suggest a lowered immune-response against human papilloma virus during the first two trimesters of pregnancy with a catch-up postpartum. Keywords: human papillomavirus; pregnancy; follow-up study; natural history; prevalence Several epidemiological and biological studies have established the important role of infection with high-risk types of human papilloma virus (HPV) for development of cervical cancer and its precursor lesions. In women with or without abnormal cervical smears a positive high-risk HPV test result indicates an increased risk for development of high grade cervical lesions (Ho et al, 1995;Remmink et al, 1995;Rozendaal et al, 1996Rozendaal et al, , 2000Nobbenhuis et al, 1999). Moreover, in nearly all cervical cancers high-risk HPV types have been detected .The increased prevalence of high grade cervical lesions and cervical cancer in immunocompromised patients, such as AIDS patients and transplant recipients, indicates that persistence of high-risk HPV and consequently HPV-mediated carcinogenesis is related to compromised immunosurveillance (IARC, 1995;Petry et al, 1996;Sun et al, 1997). Pregnancy is believed to alter immune-response in women (Schneider et al, 1987;Sethi et al, 1998). Some authors concluded pregnancy has no effect on CIN (Jain et al, 1997). Others reported high regress...

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Section: Discussionmentioning

confidence: 99%

Section: Womenmentioning

confidence: 99%

Section: Womenmentioning

confidence: 99%

“…Women were considered to be clear of infection when no high-risk HPV type from the previous visit was detected at the next visit (Nobbenhuis et al, 1999(Nobbenhuis et al, , 2001). …”

Section: Definition Of Hpv Clearancementioning

confidence: 99%

mentioning

confidence: 99%

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High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

et al. 2002

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HPV DNA Testing in Cervical Cancer Screening

Schiffman

Herrero

Hildesheim

et al. 2000

JAMA

464

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In this study population, a cut point of 1.0 pg/mL using the second generation assay permitted sensitive detection of cervical high-grade lesions and cancer, yielding an apparently optimal trade-off between high sensitivity and reasonable specificity for this test. The test will perform best in settings in which sensitive detection of high-grade lesions and cancer is paramount. Because HPV prevalence varies by population, HPV testing positive predictive value for detection of high-grade lesions and cancer will vary accordingly, with implications for utility relative to other cervical cancer screening methods.

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Human Papillomavirus Testing as a Screening Tool for Cervical Cancer

Koss¹

2000

JAMA: The Journal of the American Medical Association

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Relation of human papilloma virus status to cervical lesions and consequences for cervical-cancer screening: a prospective study

Cited by 638 publications

References 23 publications

High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

HPV DNA Testing in Cervical Cancer Screening

Human Papillomavirus Testing as a Screening Tool for Cervical Cancer

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