A study of the risks of CIN3+ detection after multiple rounds of HPV testing: Results of the 15-year cervical cancer screening experience at Kaiser Permanente Northern California |
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| Authors: | Anne Hammer Maria Demarco Nicole Campos Brian Befano Patti E Gravitt Li Cheung Thomas S Lorey Nancy Poitras Walter Kinney Nicolas Wentzensen Philip E Castle Mark Schiffman |
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| Institution: | 1. Department of Obstetrics and Gynecology, Herning Hospital, Herning, Denmark;2. Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute, Bethesda, MD, USA;3. Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA;4. Information Management Services Inc., Calverton, MD, USA;5. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA;6. Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, USA;7. Albert Einstein College of Medicine, Bronx, NY, USA |
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| Abstract: | Many countries are transitioning to HPV testing for cervical cancer screening, despite a lack of long-term experience. To anticipate multi-round screening performance, we analyzed 15-year HPV testing results at Kaiser Permanente Northern California (KPNC). We evaluated HPV test result patterns among women aged 30–64 undergoing triennial HPV/cytology cotesting at KPNC during 2003–2018. We calculated incidence rates and proportion of CIN3+ diagnoses associated with the most frequent HPV testing patterns overall and stratified by age. From 2003 to 2018, a total of 1,361,581 women had a valid HPV test result, and 7,087 were diagnosed with CIN3+. Incidence rates of CIN3+ after HPV positivity were lowest when HPV detection was new and highest in women with prevalent infections (770 vs. 13,910/100,000 person-years). Repeat test negativity reduced subsequent incidence rates of CIN3+ to extremely low levels (18/100,000 person-years following four consecutive negative results). For mixed patterns of positivity/negativity, the recency and frequency of positive tests were associated with increased rates of CIN3+ diagnosis. Most CIN3+ cases (76%) were diagnosed in women who were positive at baseline (the first known positive HPV result); 16% were attributed to apparent newly detected infections and 3% to possible reappearing infections. These results corroborate previous findings that current HPV positivity, particularly when prevalent rather than new, is associated with the highest rates of CIN3+. In a screening program implementing HPV testing, most CIN3+ is detected at the first HPV positive test. |
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| Keywords: | cervical cancer screening HPV epidemiology |
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