TY - JOUR
T1 - Risk stratification using human papillomavirus testing among women with equivocally abnormal cytology
T2 - Results from a state-wide surveillance program
AU - New Mexico HPV Pap Registry Steering Committee
AU - Gage, Julia C.
AU - Hunt, William C.
AU - Schiffman, Mark
AU - Katki, Hormuzd A.
AU - Cheung, Li C.
AU - Cuzick, Jack
AU - Myers, Orrin
AU - Castle, Philip E.
AU - Wheeler, Cosette M.
N1 - Funding Information:
Members of the New Mexico HPV Pap Registry (NMHPVPR) Steering Committee reviewed and gave input to the manuscript and supported the concept and directions of theNMHPVPR including the evaluations presented in this manuscript. The NMHPVPR Steering members participating in this effort are as follows: Nancy E. Joste, MD, University of New Mexico Health Sciences Center and Tricore Reference Laboratories, Albuquerque, New Mexico;Walter Kinney, MD, Kaiser Permanente Northern California; Cosette M. Wheeler, PhD, University of New Mexico Health Sciences Center; William C. Hunt, MS, University of New Mexico Health Sciences Center; Alan Waxman, MD, MPH, University of New Mexico Health Sciences Center; David Espey, MD, U.S. Centers for Disease Control and Prevention; Scott Norville,NewMexico Department of Health; Jane McGrath, MD, University of New Mexico Health Sciences Center; Steven Jenison, MD, Community Member; Mark Schiffman, MD, MPH, U.S. National Cancer Institute; Philip E. Castle, PhD, MPH, Albert Einstein School of Medicine; Vicki Benard, PhD, U.S. Centers for Disease Control and Prevention; Debbie Saslow, PhD, American Cancer Society; Jane J. Kim, PhD, Harvard School of Public Health;Mark H. Stoler, MD, University of Virginia; Jack Cuzick, PhD, Wolfson Institute of Preventive Medicine, London; Giovanna Rossi Pressley, MSc, Collective Action Strategies, and RWJF Center for Health Policy at University of New Mexico; and Kevin English, RPh, MPH, Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC). No compensation was received for contributions to this manuscript by any named authors or by the NMHPVPR Steering Committee members. M. Schiffman and J.C. Gage have received HPV testing of NCI specimens, not materials, for research at no cost from Roche and BectonDickinson. P.E. Castle has receivedHPVtests and testing for research at reduced or no cost from Qiagen and Roche. This effort was supported by U54CA164336 (to C.M. Wheeler) from the U.S. National Cancer Institute-funded Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium and in part by the Intramural Research Program of the National Cancer Institute, National Institutes ofHealth,Department ofHealth andHumanServices. The overall aim of PROSPR is to conduct multisite, coordinated, transdisciplinary research to evaluate and improve cancer screening processes. J. Cuzick has received research funding and reagents from Qiagen, Roche, Genprobe/Hologic, Abbott, Becton Dickinson, Cepheid, Genera, and Travogene. C.M. Wheeler has received funding through the University of New Mexico from Merck and Co., Inc. and GlaxoSmithKline for HPV vaccine studies and equipment and reagents from Roche Molecular Systems for HPV genotyping.
Publisher Copyright:
©2015 AACR.
PY - 2016/1
Y1 - 2016/1
N2 - Background: Clinical guidelines for cervical cancer screening have incorporated comparative risks of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) for various screening outcomes to determine management. Few cohorts are large enough to distinguish CIN3+ risks among women with minor abnormalities versus negative cytology because of low incidence. The New Mexico Human Papillomavirus (HPV) Pap Registry offers a unique opportunity to evaluate cervical cancer screening in a diverse population across a broad-spectrum of health service delivery. Methods: Kaplan-Meier and logistic-Weibull survival models were used to estimate cumulative risks of CIN3+ among women ages 21 to 64 who were screened in New Mexico between 2007 and 2011 with negative, equivocal or mildly abnormal cytology, that is, atypical squamous cells of undetermined significance (ASC-US; with or without HPV triage), or low-grade squamous intraepithelial lesions (LSIL). Results: We identified 452,045 women meeting the selection criteria. The 3-year CIN3+ risks for women with negative, ASC-US, and LSIL cytology were 0.30%, 2.6%, and 5.2%, respectively. HPV triage of ASC-US stratified 3-year CIN3+ risks were 0.72% for HPV-negative and 7.7% for HPV-positive. Risks tended to decline after age 30 for all screening results. Conclusions: In this state-wide population-based cohort, cytology and HPV triage of ASC-US stratified women's CIN3+ risk into similar patterns observed previously, suggesting the validity of screening guidelines for diverse populations in the United States. Absolute risk estimates should be compared across other large populations. Impact: Strategies for HPV triage of ASC-US derived from clinical trials are upheld in large clinical practice settings and across diverse screening populations in the United States.
AB - Background: Clinical guidelines for cervical cancer screening have incorporated comparative risks of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) for various screening outcomes to determine management. Few cohorts are large enough to distinguish CIN3+ risks among women with minor abnormalities versus negative cytology because of low incidence. The New Mexico Human Papillomavirus (HPV) Pap Registry offers a unique opportunity to evaluate cervical cancer screening in a diverse population across a broad-spectrum of health service delivery. Methods: Kaplan-Meier and logistic-Weibull survival models were used to estimate cumulative risks of CIN3+ among women ages 21 to 64 who were screened in New Mexico between 2007 and 2011 with negative, equivocal or mildly abnormal cytology, that is, atypical squamous cells of undetermined significance (ASC-US; with or without HPV triage), or low-grade squamous intraepithelial lesions (LSIL). Results: We identified 452,045 women meeting the selection criteria. The 3-year CIN3+ risks for women with negative, ASC-US, and LSIL cytology were 0.30%, 2.6%, and 5.2%, respectively. HPV triage of ASC-US stratified 3-year CIN3+ risks were 0.72% for HPV-negative and 7.7% for HPV-positive. Risks tended to decline after age 30 for all screening results. Conclusions: In this state-wide population-based cohort, cytology and HPV triage of ASC-US stratified women's CIN3+ risk into similar patterns observed previously, suggesting the validity of screening guidelines for diverse populations in the United States. Absolute risk estimates should be compared across other large populations. Impact: Strategies for HPV triage of ASC-US derived from clinical trials are upheld in large clinical practice settings and across diverse screening populations in the United States.
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U2 - 10.1158/1055-9965.EPI-15-0669
DO - 10.1158/1055-9965.EPI-15-0669
M3 - Article
C2 - 26518316
AN - SCOPUS:84955237859
SN - 1055-9965
VL - 25
SP - 36
EP - 42
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
IS - 1
ER -
