Type specific persistence of high risk human papillomavirus (HPV) as indicator of high grade cervical squamous intraepithelial lesions in young women: population based prospective follow up study.
OBJECTIVE
To investigate the role of human papillomavirus (HPV) in the development of cervical neoplasia in women with no previous cervical cytological abnormalities; whether the presence of virus DNA predicts development of squamous intraepithelial lesion; and whether the risk of incident squamous intraepithelial lesions differs with repeated detection of the same HPV type versus repeated detection of different types.


METHODS
Population based prospective cohort study.


METHODS
General population in Copenhagen, Denmark.


METHODS
10 758 women aged 20-29 years followed up for development of cervical cytological abnormalities; 370 incident cases were detected (40 with atypical squamous cells of undetermined significance, 165 with low grade squamous intraepithelial lesions, 165 with high grade squamous intraepithelial lesions).


METHODS
RESULTS of cervical smear tests and cervical swabs at enrollment and at the second examination about two years later.


RESULTS
Compared with women who were negative for human papillomavirus at enrollment, those with positive results had a significantly increased risk at follow up of having atypical cells (odds ratio 3.2, 95% confidence interval 1.3 to 7.9), low grade lesions (7.5, 4.8 to 11.7), or high grade lesions (25.8, 15.3 to 43.6). Similarly, women who were positive for HPV at the second examination had a strongly increased risk of low (34.3, 17.6 to 67.0) and high grade lesions (60.7, 25.5 to 144.0). For high grade lesions the risk was strongly increased if the same virus type was present at both examinations (813.0, 168.2 to 3229.2).


CONCLUSIONS
Infection with human papillomavirus precedes the development of low and high grade squamous intraepithelial lesions. For high grade lesions the risk is greatest in women positive for the same type of HPV on repeated testing.
Kjaer
Susanne K
SK
Danish Cancer Society, Institute of Cancer Epidemiology, DK-2100 Copenhagen, Denmark. susanne@cancer.dk
van den Brule
Adriaan J C
AJ
Paull
Gerson
G
Svare
Edith I
EI
Sherman
Mark E
ME
Thomsen
Birthe L
BL
Suntum
Mette
M
Bock
Johannes E
JE
Poll
Paul A
PA
Meijer
Chris J L M
CJ
D000328:Adult; D003718:Denmark / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000821:virology*; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000821:virology*