The Correlation Between Human Papillomavirus Positivity and Abnormal Cervical Cytology Result Differs by Age Among Perimenopausal Women

Abstract

Objectives We explored the age-stratified correlates and correlations between HR-HPV infection and cervical abnormalities in perimenopausal women. Materials and methods HPV testing and Pap smear screening were performed at baseline on 841 routinely screened women age 35–60 years in the HPV in Perimenopause (HIP) cohort. Demographic, behavioral and medical information was collected through telephone administered questionnaires. Descriptive analyses were used to examine the correlation between HR-HPV infection and cervical abnormalities by age. Logistic regression was used to determine correlates of HPV and abnormalities in women under and over 45 years of age. Results The prevalence of HPV, HR-HPV and cervical abnormalities decreased significantly with increasing age, as did the correlation between HR-HPV and cervical abnormalities. The prevalence of HR-HPV was 50% among younger women with abnormalities but this decreased steadily to 20% HR-HPV detection among 50–54 year old, and no abnormalities were detected in 55–60 year old women. Different correlates of HR-HPV infection and abnormalities were observed in women ≥45 years, a pattern not seen in the younger women. Conclusions Although the relative proportion of low and high-grade abnormalities did not change with age, we saw a loss of concordance between HR-HPV detection and cytological abnormalities with increasing age. Current guidelines for cervical cancer screening group together all women age 30 and above. Our data raise important questions about the interpretation of HPV and Pap test results in this age group and suggest that ongoing surveillance of HPV and cytology in cervical cancer screening programs consider a third age stratification among older women.

HPV testing results and histologic follow-up in women with ASC-H cytology in different age groups

“…More than 75% of HR-HPV-negative/ ASC-H cases were seen in age groups of 31 years and older. Our data, along with others, demonstrate a trend of consistent decrease in HR-HPV detection with increasing age among women with all grades of cervical cytology abnormality including ASC-H. 18,19 Therefore, HR-HPV testing adds little significance in younger women with ASC-H cytology, but plays an important role in increasing positive predictive value of significant cervical pathology and reducing the number of women for unnecessary colposcopy. Although >50% of women, older than 41 years, with cytologic diagnosis of ASC-H are HPV-negative, the specificity of HPV for predicting CIN2þ lesions is higher in the >40 years age group than in the 40 years age group (68.4% versus 40.1%), HR-HPV may be helpful in older women with ASC-H.…”

Similar Risk Patterns After Cervical Screening in Two Large U.S. Populations

“…Although these trends might reflect a true decline of risk as women accumulate years of cervical cancer screening, they could also be an artifact of declining sensitivity of screening or colposcopic biopsy to detect cervical precancer as women age (20, 21). Neither cohort has completely accounted for the prevalence of benign hysterectomy in the years after baseline screening.…”

Age‐stratified 5‐year risks of cervical precancer among women with enrollment and newly detectedHPVinfection

“…This is because older women are more likely to have to a long-duration persistent, and therefore higher-risk, HPV infection 9, 11-13 . We therefore expected the CIN3+ risk among women with an enrollment HPV infection to increase as well but, in fact, we saw the risks decline.…”

“…Because persistent infection with carcinogenic HPV is the true risk factor for cervical precancer and cancer, and because the proportion of prevalent infections that are persistent increases incrementally with age, it might be expected that a woman's risk of precancer following prevalent HPV detection would continue to increase with age (i.e., higher positive predictive value). Although logical, this simple model has not been consistently supported by data from cohort studies 9, 11-13 . It is possible that in a well-screened population, the aggressive persistent HPV infections are removed when women are screened at younger ages.…”