The Absolute Risk of Cervical Abnormalities in High-Risk Human Papillomavirus-Positive, Cytologically Normal Women Over a 10-Year Period

Kjær, Susanne K.; Høgdall, Estrid; Frederiksen, Kirsten

doi:10.1097/01.cot.0000265628.22571.89

Cited by 67 publications

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“…They concluded that HPV testing at 5-yearly intervals offers similar protection as cytology testing at 3-yearly intervals. 8 Clavel et al 9 reported that 5 of 4,401 women with negative cytology and HPV tests followed-up for a median of 34 months developed high-grade lesions, compared to 29 of 501 women who were initially cytology negative but HPV positive, and concluded that a screening interval of 3-5 years was safe in doubly negative women. Similar conclusions were obtained by Bulkmans et al 10 in a cohort of 2,810 cytology negative women followed for 5 years, where 4/62 HPV positive women developed CIN31 compared to 1/2,175 HPV negative women.…”

Section: Discussionmentioning

confidence: 99%

“…8 Here we update these results based on further histology results within the first year, which were not available at that time. Of the 2,988 eligible women, 6 included in the previous article were found to be included twice (due to having multiple smears within the first year all of which were negative) and the duplicates have been excluded.…”

Section: Baseline Periodmentioning

confidence: 99%

“…If so, the savings associated with longer screening intervals are likely to more than compensate for the higher test costs and the greater positivity rates per screen. 6 Five other studies [7][8][9][10][11] have reported on aspects of this issue, but they have focussed on the protection provided by being doubly negative for cytology and HPV versus being cytology negative but HPV positive. Thus these studies have sought to evaluate the role of HPV testing as an adjuvant to cytology.…”

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confidence: 99%

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Long‐term follow‐up of cervical abnormalities among women screened by HPV testing and cytology—Results from the Hammersmith study

Cuzick

Szarewski

Mesher

et al. 2008

Intl Journal of Cancer

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Several studies have shown that HPV testing is substantially more sensitive than cytology for primary cervical screening. However, less data exist concerning the duration of protection afforded by a negative HPV test compared to a normal cytological outcome. Here we report the long-term findings from the Hammersmith study in women aged 35 or more. HPV testing by Hybrid Capture II was performed on all available samples from the baseline screening visit. Passive surveillance of subsequent cytology screening results for the 2,982 women in the study was undertaken using a national registry. Histological outcomes were sought for all women with abnormal smears. The primary outcome was duration of protection against histologically confirmed CIN21 afforded by a negative HPV test compared to normal cytology. 2,516 women had at least one further smear at least 1 year after entry and 20 new cases of CIN21 were identified during a median follow-up of 6.4 years. Including disease identified at baseline, the risk of developing CIN21 at 1, 5 and 9 years after a normal cytology was 0.33%, 0.83% and 2.20% respectively whereas it was 0.19%, 0.42% and 1.88% after a negative HPV test. HPV testing offered excellent protection from CIN21 for at least 6 years after a negative test, whereas the protection from cytology began to wane after about 3 years. Substantially more CIN21 lesions were found in the followup period in those initially HPV positive compared to those HPV negative (HR 5 6.52, p 5 0.001), whereas there was little difference according to initial cytology (HR 5 1.64, p 5 0.51). ' 2008 Wiley-Liss, Inc.Key words: HPV testing; cytology; duration of protection; cervical screening High risk types of the human papillomavirus (HPV) have been shown to be the primary causal factor for invasive cervical cancer. 1,2 Several studies have clearly demonstrated that HPV testing has a much higher sensitivity for CIN than cytology. However its specificity is lower, especially for younger women. [3][4][5] The high sensitivity of HPV testing suggests that it can safely be done less frequently than cytology. If so, the savings associated with longer screening intervals are likely to more than compensate for the higher test costs and the greater positivity rates per screen. 6 Five other studies 7-11 have reported on aspects of this issue, but they have focussed on the protection provided by being doubly negative for cytology and HPV versus being cytology negative but HPV positive. Thus these studies have sought to evaluate the role of HPV testing as an adjuvant to cytology. The strengths and weaknesses of these studies are reviewed in the Discussion section. Here we investigate the duration of protection associated with a negative HPV test and compare it directly to that achieved after a negative cytology based on long-term follow-up of a study using HPV and cytology for screening which commenced in April 1994 at the Hammersmith Hospital. 12 Material and methods Patients and clinical procedures at baselineWomen from 40 general practitioner (G...

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Section: Discussionmentioning

confidence: 99%

Section: Baseline Periodmentioning

confidence: 99%

mentioning

confidence: 99%

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Long‐term follow‐up of cervical abnormalities among women screened by HPV testing and cytology—Results from the Hammersmith study

Cuzick

Szarewski

Mesher

et al. 2008

Intl Journal of Cancer

View full text Add to dashboard Cite

show abstract

“…Under this concept, a woman aged 30 -35 years or above found positive for a high-risk HPV DNA and normal in the cytological examination would be labelled as a (prevalent) false positive, weighing against specificity. Longitudinal studies have shown, however, that these cases (might be as high as 10% of screening participants) particularly if HPV DNA persists are indeed at higher risk of progression to CIN 2 þ within the next decade as compared to women who show normal cytology and are HPV negative (Lorincz and Richart, 2003;Kjaer et al, 2006). Clinically, these women are properly identified as part of the high-risk group and candidate to more intense follow-up.…”

Section: Advances In Screeningmentioning

confidence: 99%

HPV and cervical cancer: screening or vaccination?

2008

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Following the demonstration of the superior validity of human papillomavirus (HPV) tests in screening for cervical cancer and the arrival of highly efficacious HPV 16 and 18 vaccines, cervical cancer prevention enters a time of sustainable introduction in developing countries. Multidisciplinary efforts and novel protocols are being developed, and challenging situations are being faced to make cervical cancer, still the number two cancer in women worldwide, an eradicable condition. The provocative title proposed by the editors of the British Journal of Cancer could have at first sight, a quick and intuitive answer: we will need both. We need human papillomavirus (HPV) vaccines to significantly reduce the health care burden currently required for cervical cancer prevention, and we need screening because of the limitations of current HPV vaccines both in their lack of therapeutic effect (thus not protecting women with an ongoing neoplastic processes) and in their limited number of HPV types (thus leaving to evolve some 25 -30% of cervical cancer cases related to HPV types other than 16 or 18). However, the answer only applies in scenarios in which screening is already developed and reasonably efficient. In populations without adequate screening, one could equally argue that HPV vaccines at affordable prices are the only realistic option. While these arrive, more efficient screening schemes, for example with low-cost HPV tests, requiring fewer visits or strategies involving rapid intervention like 'screen and treat' protocols, remain the only option for currently living adult women. Moreover, should polyvalent vaccines (including some five -eight HPV types) result in extending protection against more than 90% þ of the oncogenic HPV types, vaccination alone would be the answer for both scenarios. Thus, a complex answer to an apparent straightforward question. PHASE III HPV VACCINATION TRIALSWith the publication of the key short-term results of the two major Phase III trials of HPV vaccines, the perspective of tackling cervical cancer prevention with vaccination has been unambiguously open. While recognising the limitations of the still moderate (5 -6 years) follow-up in a few tens of thousand young women, two vaccines to date have shown high efficacy, safety, immunogenicity, long-term duration of protection and a strong suggestions of induction of immune memory (Harper et al, 2006;Garland et al, 2007;Paavonen et al, 2007; The Future II Study Group, 2007).A number of clinically relevant issues remain to be fully described, including the magnitude and the HPV spectrum included in the cross protection effect, and the long-term effects of each of the HPV vaccines on cancer protection and safety. However, to solve these questions, it is unavoidable to continue the studies for additional follow-up time and the organisation of large Phase IV studies, some of which are already in place.The currently available vaccines offer full protection to HPV 16-and 18-naïve women for these two HPV types that cause an estimated 70% of ce...

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“…Als wesentlicher Risikofaktor für die Entstehung einer CIN-2/3-Läsion wird in unterschiedlichen Studien die persistierende HR-HPV-Infektion, insbesondere mit HPV-16, identifiziert, teilweise mit einem absoluten Risiko von bis zu 40% nach 3-bis 5-jähriger Viruspersistenz [2]. In einer groß angelegten dänischen Studie zeigten Kjaer et al nach 2-maligem HPV-16-Nachweis eine CIN-2/3-Inzidenz von 50% innerhalb von 10 Jahren [13]. Insgesamt zeigen die verschiedenen HR-HPV-Typen ein unterschiedliches Maß an transformierendem Potenzial [11,22].…”

Section: Progression Zur Krebsvorstufeunclassified

Die Infektion mit humanen Papillomaviren

Sotlar

2008

Pathologe

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The Absolute Risk of Cervical Abnormalities in High-Risk Human Papillomavirus-Positive, Cytologically Normal Women Over a 10-Year Period

Cited by 67 publications

References 0 publications

Long‐term follow‐up of cervical abnormalities among women screened by HPV testing and cytology—Results from the Hammersmith study

Long‐term follow‐up of cervical abnormalities among women screened by HPV testing and cytology—Results from the Hammersmith study

HPV and cervical cancer: screening or vaccination?

Die Infektion mit humanen Papillomaviren

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