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Long-term outcomes of high-risk human papillomavirus infection support a long interval of cervical cancer screening.

Huang YK, You SL, Yuan CC, Ke YM, Cao JM, Liao CY, Wu CH, Hsu CS, Huang KF, Lu CH, Twu NF, Chu TY - Br. J. Cancer (2008)

Bottom Line: The cumulative incidences of high-grade squamous intraepithelial lesion (HSIL) and in situ/invasive cancer in HPV-positive women were 5.6 and 3.7%, respectively, and those in HPV-negative women were 0.3 and 0%.After adjusting for other risk factors, HPV-positive subjects had 24.9 (95% CI: 7.0-108.3; P<0.0001) folds of risk of developing HSIL or above cervical neoplasia as compared to HPV-negative subjects, whereas risk for low-grade intraepithelial lesion and atypical squamous cytology was not increased.The result supports an HPV test-orientated CC screening programme with intervals of at least 5 years.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan, ROC.

ABSTRACT
Knowing that infection of high-risk human papillomavirus (HPV) causes virtually all cervical cancer (CC), the long-term outcomes of HPV infection, especially the absolute risk and time lapse of developing CC, are beyond the scope of ordinary follow-up study owing to ethical concerns. The present study followed the natural history and long-term outcomes of HPV infection in a cohort of women by national health insurance care and data linkage without additional disturbance. The status of cervical HPV infection was determined in 1708 healthy women, aged 20-90 (median 43), enrolled from 10 hospitals in seven cities around the island country of Taiwan. Records of consecutive Pap smear results and cancer reports of 108 cytology-negative, HPV-positive and 1202 cytology- and HPV-negative women with no prior record of CC or abnormal cervical cytology were retrospectively analysed for a duration of up to 75 months (median 61 months). The cumulative incidences of high-grade squamous intraepithelial lesion (HSIL) and in situ/invasive cancer in HPV-positive women were 5.6 and 3.7%, respectively, and those in HPV-negative women were 0.3 and 0%. After adjusting for other risk factors, HPV-positive subjects had 24.9 (95% CI: 7.0-108.3; P<0.0001) folds of risk of developing HSIL or above cervical neoplasia as compared to HPV-negative subjects, whereas risk for low-grade intraepithelial lesion and atypical squamous cytology was not increased. The study showed that women with a prevalent infection of high-risk HPV had a 4% cumulative risk for CC in 6 years, whereas those tested negative had little risk. The result supports an HPV test-orientated CC screening programme with intervals of at least 5 years.

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Related in: MedlinePlus

A schematic overview of the data linkage and follow-up outcomes. After exclusion of ineligible subjects, 1310 women fulfilled the follow-up criteria and the outcome classification was given.
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fig2: A schematic overview of the data linkage and follow-up outcomes. After exclusion of ineligible subjects, 1310 women fulfilled the follow-up criteria and the outcome classification was given.

Mentions: A schematic overview of the study design and case outcomes was shown in Figure 2. One hundred and twenty subjects refused the follow-up and did not provide their personal identification number (ID). The remaining 1588 subjects were passively followed by linking their ID to the Taiwan Cervical Cytology Screening and Histology Database and to the Taiwan Cancer Registry in August 2006. This data linking analysis was approved by the Bureau of Health Promotion, Department of Health, Taiwan. Among the 1588 subjects, 288 having no record of Pap smear or cancer registry data during the follow-up period were excluded. Also excluded were 14 subjects who had records of abnormal Pap smear test results (including Atypia or more severe results) or CC prior to 13 May 2000, and five subjects having CC detected on 13 May 2000. Pap smear and cancer registry data of the remaining 1310 eligible subjects were analysed. Their median age was 43 (ranged 23–80) years.


Long-term outcomes of high-risk human papillomavirus infection support a long interval of cervical cancer screening.

Huang YK, You SL, Yuan CC, Ke YM, Cao JM, Liao CY, Wu CH, Hsu CS, Huang KF, Lu CH, Twu NF, Chu TY - Br. J. Cancer (2008)

A schematic overview of the data linkage and follow-up outcomes. After exclusion of ineligible subjects, 1310 women fulfilled the follow-up criteria and the outcome classification was given.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2266853&req=5

fig2: A schematic overview of the data linkage and follow-up outcomes. After exclusion of ineligible subjects, 1310 women fulfilled the follow-up criteria and the outcome classification was given.
Mentions: A schematic overview of the study design and case outcomes was shown in Figure 2. One hundred and twenty subjects refused the follow-up and did not provide their personal identification number (ID). The remaining 1588 subjects were passively followed by linking their ID to the Taiwan Cervical Cytology Screening and Histology Database and to the Taiwan Cancer Registry in August 2006. This data linking analysis was approved by the Bureau of Health Promotion, Department of Health, Taiwan. Among the 1588 subjects, 288 having no record of Pap smear or cancer registry data during the follow-up period were excluded. Also excluded were 14 subjects who had records of abnormal Pap smear test results (including Atypia or more severe results) or CC prior to 13 May 2000, and five subjects having CC detected on 13 May 2000. Pap smear and cancer registry data of the remaining 1310 eligible subjects were analysed. Their median age was 43 (ranged 23–80) years.

Bottom Line: The cumulative incidences of high-grade squamous intraepithelial lesion (HSIL) and in situ/invasive cancer in HPV-positive women were 5.6 and 3.7%, respectively, and those in HPV-negative women were 0.3 and 0%.After adjusting for other risk factors, HPV-positive subjects had 24.9 (95% CI: 7.0-108.3; P<0.0001) folds of risk of developing HSIL or above cervical neoplasia as compared to HPV-negative subjects, whereas risk for low-grade intraepithelial lesion and atypical squamous cytology was not increased.The result supports an HPV test-orientated CC screening programme with intervals of at least 5 years.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan, ROC.

ABSTRACT
Knowing that infection of high-risk human papillomavirus (HPV) causes virtually all cervical cancer (CC), the long-term outcomes of HPV infection, especially the absolute risk and time lapse of developing CC, are beyond the scope of ordinary follow-up study owing to ethical concerns. The present study followed the natural history and long-term outcomes of HPV infection in a cohort of women by national health insurance care and data linkage without additional disturbance. The status of cervical HPV infection was determined in 1708 healthy women, aged 20-90 (median 43), enrolled from 10 hospitals in seven cities around the island country of Taiwan. Records of consecutive Pap smear results and cancer reports of 108 cytology-negative, HPV-positive and 1202 cytology- and HPV-negative women with no prior record of CC or abnormal cervical cytology were retrospectively analysed for a duration of up to 75 months (median 61 months). The cumulative incidences of high-grade squamous intraepithelial lesion (HSIL) and in situ/invasive cancer in HPV-positive women were 5.6 and 3.7%, respectively, and those in HPV-negative women were 0.3 and 0%. After adjusting for other risk factors, HPV-positive subjects had 24.9 (95% CI: 7.0-108.3; P<0.0001) folds of risk of developing HSIL or above cervical neoplasia as compared to HPV-negative subjects, whereas risk for low-grade intraepithelial lesion and atypical squamous cytology was not increased. The study showed that women with a prevalent infection of high-risk HPV had a 4% cumulative risk for CC in 6 years, whereas those tested negative had little risk. The result supports an HPV test-orientated CC screening programme with intervals of at least 5 years.

Show MeSH
Related in: MedlinePlus