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Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines

OBJECTIVES: The next round of the American Society for Colposcopy and Cervical Pathology (ASCCP)-sponsored cervical cancer screening and management guidelines will recommend clinical actions based on risk, rather than test-based algorithms. This article gives preliminary risk estimates for the scree...

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Autores principales: Demarco, Maria, Lorey, Thomas S., Fetterman, Barbara, Cheung, Li C., Guido, Richard S., Wentzensen, Nicolas, Kinney, Walter K., Poitras, Nancy E., Befano, Brian, Castle, Philip E., Schiffman, Mark
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625966/
https://www.ncbi.nlm.nih.gov/pubmed/28953116
http://dx.doi.org/10.1097/LGT.0000000000000343
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author Demarco, Maria
Lorey, Thomas S.
Fetterman, Barbara
Cheung, Li C.
Guido, Richard S.
Wentzensen, Nicolas
Kinney, Walter K.
Poitras, Nancy E.
Befano, Brian
Castle, Philip E.
Schiffman, Mark
author_facet Demarco, Maria
Lorey, Thomas S.
Fetterman, Barbara
Cheung, Li C.
Guido, Richard S.
Wentzensen, Nicolas
Kinney, Walter K.
Poitras, Nancy E.
Befano, Brian
Castle, Philip E.
Schiffman, Mark
author_sort Demarco, Maria
collection PubMed
description OBJECTIVES: The next round of the American Society for Colposcopy and Cervical Pathology (ASCCP)-sponsored cervical cancer screening and management guidelines will recommend clinical actions based on risk, rather than test-based algorithms. This article gives preliminary risk estimates for the screening setting, showing combinations of the 2 most important predictors, human papillomavirus (HPV) status and cytology result. MATERIALS AND METHODS: Among 1,262,713 women aged 25 to 77 years co-tested with HC2 (Qiagen) and cytology at Kaiser Permanente Northern California, we estimated 0–5-year cumulative risk of cervical intraepithelial neoplasia (CIN) 2+, CIN 3+, and cancer for combinations of cytology (negative for intraepithelial lesion or malignancy [NILM], atypical squamous cells of undetermined significance [ASC-US], low-grade squamous intraepithelial lesion [LSIL], atypical squamous cells cannot exclude HSIL [ASC-H], high-grade squamous intraepithelial lesion [HSIL], atypical glandular cells [AGC]) and HPV status. RESULTS: Ninety percent of screened women had HPV-negative NILM and an extremely low risk of subsequent cancer. Five-year risks of CIN 3+ were lower after HPV negativity (0.12%) than after NILM (0.25%). Among HPV-negative women, 5-year risks for CIN 3+ were 0.10% for NILM, 0.44% for ASC-US, 1.8% for LSIL, 3.0% for ASC-H, 1.2% for AGC, and 29% for HSIL+ cytology (which was very rare). Among HPV-positive women, 5-year risks were 4.0% for NILM, 6.8% for ASC-US, 6.1% for LSIL, 28% for ASC-H, 30% for AGC, and 50% for HSIL+ cytology. CONCLUSIONS: As a foundation for the next guidelines revision, we confirmed with additional precision the risk estimates previously reported for combinations of HPV and cytology. Future analyses will estimate risks for women being followed in colposcopy clinic and posttreatment and will consider the role of risk modifiers such as age, HPV vaccine status, HPV type, and screening and treatment history.
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spelling pubmed-56259662017-10-17 Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines Demarco, Maria Lorey, Thomas S. Fetterman, Barbara Cheung, Li C. Guido, Richard S. Wentzensen, Nicolas Kinney, Walter K. Poitras, Nancy E. Befano, Brian Castle, Philip E. Schiffman, Mark J Low Genit Tract Dis Original Research Articles: Cervix and HPV OBJECTIVES: The next round of the American Society for Colposcopy and Cervical Pathology (ASCCP)-sponsored cervical cancer screening and management guidelines will recommend clinical actions based on risk, rather than test-based algorithms. This article gives preliminary risk estimates for the screening setting, showing combinations of the 2 most important predictors, human papillomavirus (HPV) status and cytology result. MATERIALS AND METHODS: Among 1,262,713 women aged 25 to 77 years co-tested with HC2 (Qiagen) and cytology at Kaiser Permanente Northern California, we estimated 0–5-year cumulative risk of cervical intraepithelial neoplasia (CIN) 2+, CIN 3+, and cancer for combinations of cytology (negative for intraepithelial lesion or malignancy [NILM], atypical squamous cells of undetermined significance [ASC-US], low-grade squamous intraepithelial lesion [LSIL], atypical squamous cells cannot exclude HSIL [ASC-H], high-grade squamous intraepithelial lesion [HSIL], atypical glandular cells [AGC]) and HPV status. RESULTS: Ninety percent of screened women had HPV-negative NILM and an extremely low risk of subsequent cancer. Five-year risks of CIN 3+ were lower after HPV negativity (0.12%) than after NILM (0.25%). Among HPV-negative women, 5-year risks for CIN 3+ were 0.10% for NILM, 0.44% for ASC-US, 1.8% for LSIL, 3.0% for ASC-H, 1.2% for AGC, and 29% for HSIL+ cytology (which was very rare). Among HPV-positive women, 5-year risks were 4.0% for NILM, 6.8% for ASC-US, 6.1% for LSIL, 28% for ASC-H, 30% for AGC, and 50% for HSIL+ cytology. CONCLUSIONS: As a foundation for the next guidelines revision, we confirmed with additional precision the risk estimates previously reported for combinations of HPV and cytology. Future analyses will estimate risks for women being followed in colposcopy clinic and posttreatment and will consider the role of risk modifiers such as age, HPV vaccine status, HPV type, and screening and treatment history. Lippincott Williams & Wilkins 2017-10 2017-09-26 /pmc/articles/PMC5625966/ /pubmed/28953116 http://dx.doi.org/10.1097/LGT.0000000000000343 Text en Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society for Colposcopy and Cervical Pathology. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Research Articles: Cervix and HPV
Demarco, Maria
Lorey, Thomas S.
Fetterman, Barbara
Cheung, Li C.
Guido, Richard S.
Wentzensen, Nicolas
Kinney, Walter K.
Poitras, Nancy E.
Befano, Brian
Castle, Philip E.
Schiffman, Mark
Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines
title Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines
title_full Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines
title_fullStr Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines
title_full_unstemmed Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines
title_short Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines
title_sort risks of cin 2+, cin 3+, and cancer by cytology and human papillomavirus status: the foundation of risk-based cervical screening guidelines
topic Original Research Articles: Cervix and HPV
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625966/
https://www.ncbi.nlm.nih.gov/pubmed/28953116
http://dx.doi.org/10.1097/LGT.0000000000000343
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