DOI: 10.1097/01.COT.0000265628.22571.89
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Issn Print: 0276-2234
Publication Date: 2007/01/10
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Excerpt
A single high-risk HPV-positive test in older women at baseline was associated with high absolute risk of developing cytologic abnormalities. A single negative HPV test at baseline had a high negative predictive value ≥99%) for developing cervical intraepithelial neoplasia at five years for both older (40–50 years old) and younger women (22–32 years old) in this large-scale prospective study with a long-term follow-up.
Following baseline negative Pap smears and concurrently positive HPV DNA tests, approximately 25% of older women developed cytologic abnormalities within five years, and 35% within 10 years. These five- and 10-year risk estimates were higher than those of women with negative cytology and negative HPV DNA tests, which were 4% and 10%, respectively.
The high absolute risk of subsequent cervical cancer among HPV-positive and Pap smear-negative women was also seen in the younger cohort, with an 18% risk after five years and 24% after 10 years.
In this group, two negative HPV tests had a greater negative predictive value than one, and a second positive test significantly increased the absolute risk and positive predictive value.
The HPV tests were done with the Hybrid Capture II test. Further analysis for specific HPV subtypes may be necessary to distinguish between infections that may be pre-cancerous and those that require less intensive management, the authors note.
The study cohorts participated in two population-based studies in Copenhagen. A strength of this study, its authors claim, is that there was almost no loss to follow-up. However, the study may be limited by not being a randomized trial, but based rather on everyday clinical management, they added.
Cancer Res 2006;66:10630–10636.
