Long-term follow-up of cervical disease in women screened by cytology and HPV testing: results from the HART study.
BACKGROUND
Several studies have shown that testing for high-risk human papillomavirus (HPV) types results in an improved sensitivity for CIN2+, compared with cytology, although with a somewhat lower specificity.


METHODS
We obtained follow-up results, with at least one smear after participation in the HART study, which compared HPV testing (HC-II) with cytology as a primary screening modality.


RESULTS
With a median follow-up of 6 years, 42 additional cases of CIN2+ were identified; women who were HPV positive at baseline were more likely to develop CIN2+ than those who were HPV negative (hazard ratio (HR) 17.2; 95% confidence interval (CI) (9.3-31.6)) and the risk increased with increasing viral load. Compared with HPV-negative women (relative light unit (RLU) <1), the HR (95% CI) was 5.4 (1.6, 18.2) for 1-10 RLU and 25.5 (13.6, 47.9) for RLU > or = 10. Positive cytology (borderline or worse compared with negative) was also predictive of developing CIN2, although to a lesser extent (HR 8.7; 95% CI (4.5-17.1)). Only one case of CIN3 and three cases of CIN2 were found in women who showed a positive cytology result but were HPV negative at baseline.


CONCLUSIONS
After 5 years of follow-up, CIN2+ occurred in 0.23% of women who were HPV negative at baseline compared with 0.48% of women who showed a negative cytology result, indicating a much longer low-risk interval for CIN2+ after HPV testing.
Mesher
D
D
Cancer Research UK Centre for Epidemiology, Mathematics & Statistics, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Charterhouse Square, LondonEC1 M 6BQ, UK.
Szarewski
A
A
Cadman
L
L
Cubie
H
H
Kitchener
H
H
Luesley
D
D
Menon
U
U
Hulman
G
G
Desai
M
M
Ho
L
L
Terry
G
G
Williams
A
A
Sasieni
P
P
Cuzick
J
J
D000328:Adult; D052685:Alphapapillomavirus / Q000302:isolation & purification*; D004739:England; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009367:Neoplasm Staging; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000473:pathology; D016016:Proportional Hazards Models; D018570:Risk Assessment; D002577:Uterine Cervical Diseases / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears; D019562:Viral Load; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000473:pathology / Q000821:virology