TY - JOUR
T1 - Outcomes in women with cytology showing atypical squamous cells of undetermined significance with vs without human papillomavirus testing
AU - New Mexico HPV Pap Registry Steering Committee
AU - Cuzick, Jack
AU - Myers, Orrin
AU - Lee, Ji Hyun
AU - Shi, Yang
AU - Gage, Julia C.
AU - Hunt, William C.
AU - Robertson, Michael
AU - Wheeler, Cosette M.
N1 - Funding Information:
receiving personal income from advisory boards or speakers bureaus from Abbott, Becton Dickinson, Cepheid, Merck, and Trovagene and receiving grants to Queen Mary University of London from Abbott, Becton Dickinson, Cepheid, Hologic, OncoHealth, Qiagen, and Trovagene during the conduct of the study. Dr Wheeler reports receiving grants to the University of New Mexico from the US National Cancer Institute and the National Institute of Allergy and Infectious Diseases during the conduct of the study and receiving other support to the University of New Mexico from GSK, Merck, and Roche Molecular Systems outside of the submitted work. No other disclosures were reported.
Funding Information:
Funding/Support: This study was supported by grant U54CA164336 (to Dr Wheeler) from the US National Cancer Institute–funded Population-Based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium.
Funding Information:
Dr Cuzick reports receiving personal income from advisory boards or speakers bureaus from Abbott, Becton Dickinson, Cepheid, Merck, and Trovagene and receiving grants to Queen Mary University of London from Abbott, Becton Dickinson, Cepheid, Hologic, OncoHealth, Qiagen, and Trovagene during the conduct of the study. Dr Wheeler reports receiving grants to the University of New Mexico from the US National Cancer Institute and the National Institute of Allergy and Infectious Diseases during the conduct of the study and receiving other support to the University of New Mexico from GSK, Merck, and Roche Molecular Systems outside of the submitted work. No other disclosures were reported. This study was supported by grant U54CA164336 (to Dr Wheeler) from the US National Cancer Institute–funded Population-Based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium. The overall aim of PROSPR is to conduct multisite, coordinated, transdisciplinary research to evaluate and improve cancer screening processes.
Publisher Copyright:
© 2017 American Medical Association. All rights reserved.
PY - 2017/10
Y1 - 2017/10
N2 - IMPORTANCE: Little is known about the long-term yield of high-grade cervical intraepithelial neoplasia (CIN) and the influence on biopsy and treatment rates of human papillomavirus (HPV) triage of cytology showing atypical squamous cells of undetermined significance (hereafter ASC-US cytology). OBJECTIVE: To examine 5-year outcomes after ASC-US cytology with vs without HPV testing. DESIGN, SETTING, AND PARTICIPANTS: In this observational study, all cervical cytology and HPV testing reports from January 1, 2007, to December 31, 2012, were obtained for women throughout New Mexico and linked to pathology reports. The dates of the analysis were May 4, 2015, to January 13, 2017. MAIN OUTCOMES AND MEASURES: Influence of HPV testing on disease yield, time to histologically confirmed disease, and biopsy or loop electrosurgical excision procedure rates. RESULTS: A total of 457 317 women (mean [SD] age, 39.8 [12.5] years) with a screening test were recorded between 2008 and 2012, and 20 677 (4.5%) of the first cytology results per woman were reported as ASC-US. CIN grade 3 or more severe (CIN3+) lesions were detected in 2.49% of women with HPV testing vs 2.15% of women without HPV testing (P = .23). Time to CIN3+ detection was much shorter in those with HPV testing vs those without testing (median, 103 vs 393 days; P < .001). CIN grade 1 was detected in 11.6% of women with HPV testing vs 6.6% without testing (relative risk, 1.76; 95% CI, 1.56-2.00; P < .001). Loop electrosurgical excision procedure rates within 5 years were 20.0% higher in those who underwent HPV testing, resulting in more CIN2+ and CIN3+ detection. CONCLUSIONS AND RELEVANCE: Human papillomavirus testing led to faster and more complete diagnosis of cervical disease, but 55.8% more biopsies and 20.0% more loop electrosurgical excision procedures were performed. In those tested, virtually all high-grade disease occurred in the 43.1% of women who were HPV positive, allowing clinical resources to be focused on women who need them most. These data provide essential information for cervical screening guidelines and public health policy.
AB - IMPORTANCE: Little is known about the long-term yield of high-grade cervical intraepithelial neoplasia (CIN) and the influence on biopsy and treatment rates of human papillomavirus (HPV) triage of cytology showing atypical squamous cells of undetermined significance (hereafter ASC-US cytology). OBJECTIVE: To examine 5-year outcomes after ASC-US cytology with vs without HPV testing. DESIGN, SETTING, AND PARTICIPANTS: In this observational study, all cervical cytology and HPV testing reports from January 1, 2007, to December 31, 2012, were obtained for women throughout New Mexico and linked to pathology reports. The dates of the analysis were May 4, 2015, to January 13, 2017. MAIN OUTCOMES AND MEASURES: Influence of HPV testing on disease yield, time to histologically confirmed disease, and biopsy or loop electrosurgical excision procedure rates. RESULTS: A total of 457 317 women (mean [SD] age, 39.8 [12.5] years) with a screening test were recorded between 2008 and 2012, and 20 677 (4.5%) of the first cytology results per woman were reported as ASC-US. CIN grade 3 or more severe (CIN3+) lesions were detected in 2.49% of women with HPV testing vs 2.15% of women without HPV testing (P = .23). Time to CIN3+ detection was much shorter in those with HPV testing vs those without testing (median, 103 vs 393 days; P < .001). CIN grade 1 was detected in 11.6% of women with HPV testing vs 6.6% without testing (relative risk, 1.76; 95% CI, 1.56-2.00; P < .001). Loop electrosurgical excision procedure rates within 5 years were 20.0% higher in those who underwent HPV testing, resulting in more CIN2+ and CIN3+ detection. CONCLUSIONS AND RELEVANCE: Human papillomavirus testing led to faster and more complete diagnosis of cervical disease, but 55.8% more biopsies and 20.0% more loop electrosurgical excision procedures were performed. In those tested, virtually all high-grade disease occurred in the 43.1% of women who were HPV positive, allowing clinical resources to be focused on women who need them most. These data provide essential information for cervical screening guidelines and public health policy.
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U2 - 10.1001/jamaoncol.2017.1040
DO - 10.1001/jamaoncol.2017.1040
M3 - Article
C2 - 28655061
AN - SCOPUS:85021437434
SN - 2374-2437
VL - 3
SP - 1327
EP - 1334
JO - JAMA Oncology
JF - JAMA Oncology
IS - 10
ER -