We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Effect of Several Negative Rounds of Human Papillomavirus and Cytology Co-testing on Safety Against Cervical Cancer: An Observational Cohort Study.
- Authors
Castle, Philip E.; Kinney, Walter K.; Xue, Xiaonan; Cheung, Li C.; Gage, Julia C.; Zhao, Fang-Hui; Fetterman, Barbara; Poitras, Nancy E.; Lorey, Thomas S.; Wentzensen, Nicolas; Katki, Hormuzd A.; Schiffman, Mark
- Abstract
<bold>Background: </bold>Current U.S. cervical cancer screening and management guidelines do not consider previous screening history, because data on multiple-round human papillomavirus (HPV) and cytology "co-testing" have been unavailable.<bold>Objective: </bold>To measure cervical cancer risk in routine practice after successive negative screening co-tests at 3-year intervals.<bold>Design: </bold>Observational cohort study.<bold>Setting: </bold>Integrated health care system (Kaiser Permanente Northern California, Oakland, California).<bold>Patients: </bold>990 013 women who had 1 or more co-tests from 2003 to 2014.<bold>Measurements: </bold>3- and 5-year cumulative detection of (risk for) cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ, and cervical cancer (≥CIN3) in women with different numbers of negative co-tests, overall and within subgroups defined by previous co-test results or baseline age.<bold>Results: </bold>Five-year ≥CIN3 risks decreased after each successive negative co-test screening round (0.098%, 0.052%, and 0.035%). Five-year ≥CIN3 risks for an HPV-negative co-test, regardless of the cytology result, nearly matched the performance (reassurance) of a negative co-test for each successive round of screening (0.114%, 0.061%, and 0.041%). By comparison, ≥CIN3 risks for the cytology-negative co-test, regardless of the HPV result, also decreased with each successive round, but 3-year risks were as high as 5-year risks after an HPV-negative co-test (0.199%, 0.065%, and 0.043%). No interval cervical cancer cases were diagnosed after the second negative co-test. Independently, ≥CIN3 risks decreased with age. Length of previous screening interval did not influence future ≥CIN3 risks.<bold>Limitation: </bold>Interval-censored observational data.<bold>Conclusion: </bold>After 1 or more negative cervical co-tests (or HPV tests), longer screening intervals (every 5 years or more) might be feasible and safe.<bold>Primary Funding Source: </bold>National Cancer Institute Intramural Research Program.
- Subjects
CALIFORNIA; PAPILLOMAVIRUS diseases; CYTOLOGY; CERVICAL cancer treatment; HUMAN papillomavirus vaccines; MEDICAL screening; ADENOCARCINOMA; COLPOSCOPY; PAP test; PAPILLOMAVIRUSES; CERVIX uteri tumors; CARCINOMA in situ; CERVICAL intraepithelial neoplasia; TUMOR grading
- Publication
Annals of Internal Medicine, 2018, Vol 168, Issue 1, p20
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/M17-1609