Outcomes in women with cytology showing atypical squamous cells of undetermined significance with vs without human papillomavirus testing

New Mexico HPV Pap Registry Steering Committee

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1327-1334
Number of pages8
JournalJAMA Oncology
Volume3
Issue number10
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

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Cell Biology
Cervical Intraepithelial Neoplasia
Biopsy
Atypical Squamous Cells of the Cervix
Pyridinolcarbamate
Triage
Public Policy
Health Policy
Observational Studies
Public Health
Outcome Assessment (Health Care)
Guidelines
Pathology

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Outcomes in women with cytology showing atypical squamous cells of undetermined significance with vs without human papillomavirus testing. / New Mexico HPV Pap Registry Steering Committee.

In: JAMA Oncology, Vol. 3, No. 10, 01.10.2017, p. 1327-1334.

Research output: Contribution to journalArticle

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title = "Outcomes in women with cytology showing atypical squamous cells of undetermined significance with vs without human papillomavirus testing",
abstract = "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.",
author = "{New Mexico HPV Pap Registry Steering Committee} and Jack Cuzick and Orrin Myers and Lee, {Ji Hyun} and Yang Shi and Gage, {Julia C.} and Hunt, {William C.} and Michael Robertson and Wheeler, {Cosette M.}",
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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.

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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.

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