title: Long-term outcomes of high-risk human papillomavirus infection support a long interval of cervical cancer screening.
abstract: Knowing that infection of high-risk human papillomavirus (HPV) causes virtually all cervical cancer (CC), the long-term outcomes of HPV infection, especially the absolute risk and time lapse of developing CC, are beyond the scope of ordinary follow-up study owing to ethical concerns. The present study followed the natural history and long-term outcomes of HPV infection in a cohort of women by national health insurance care and data linkage without additional disturbance. The status of cervical HPV infection was determined in 1708 healthy women, aged 20-90 (median 43), enrolled from 10 hospitals in seven cities around the island country of Taiwan. Records of consecutive Pap smear results and cancer reports of 108 cytology-negative, HPV-positive and 1202 cytology- and HPV-negative women with no prior record of CC or abnormal cervical cytology were retrospectively analysed for a duration of up to 75 months (median 61 months). The cumulative incidences of high-grade squamous intraepithelial lesion (HSIL) and in situ/invasive cancer in HPV-positive women were 5.6 and 3.7%, respectively, and those in HPV-negative women were 0.3 and 0%. After adjusting for other risk factors, HPV-positive subjects had 24.9 (95% CI: 7.0-108.3; P<0.0001) folds of risk of developing HSIL or above cervical neoplasia as compared to HPV-negative subjects, whereas risk for low-grade intraepithelial lesion and atypical squamous cytology was not increased. The study showed that women with a prevalent infection of high-risk HPV had a 4% cumulative risk for CC in 6 years, whereas those tested negative had little risk. The result supports an HPV test-orientated CC screening programme with intervals of at least 5 years.
authors.affiliation: Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan, ROC.
authors.forename: Y-K
authors.initials: YK
authors.lastname: Huang
authors.forename: S-L
authors.initials: SL
authors.lastname: You
authors.forename: C-C
authors.initials: CC
authors.lastname: Yuan
authors.forename: Y-M
authors.initials: YM
authors.lastname: Ke
authors.forename: J-M
authors.initials: JM
authors.lastname: Cao
authors.forename: C-Y
authors.initials: CY
authors.lastname: Liao
authors.forename: C-H
authors.initials: CH
authors.lastname: Wu
authors.forename: C-S
authors.initials: CS
authors.lastname: Hsu
authors.forename: K-F
authors.initials: KF
authors.lastname: Huang
authors.forename: C-H
authors.initials: CH
authors.lastname: Lu
authors.forename: N-F
authors.initials: NF
authors.lastname: Twu
authors.forename: T-Y
authors.initials: TY
authors.lastname: Chu
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears
chemical_list: D004279:DNA, Viral