title: A long-term prospective study of type-specific human papillomavirus infection and risk of cervical neoplasia among 20,000 women in the Portland Kaiser Cohort Study.
abstract: BACKGROUND
  Human papillomavirus (HPV) DNA testing is more sensitive than cytology for detection of cervical intraepithelial neoplasia grade 3 and cancer (≥CIN3). Adding HPV testing to cytology is recommended for women ≥30 but long-term prospective studies of HPV testing are rare.
  
  
  METHODS
  Beginning in 1989-1990, ~20,000 women in a prepaid health maintenance organization (median age = 34) were followed passively by recommended annual cytology. We tested archived cervicovaginal lavage specimens collected at enrollment, primarily by MY09-MY11 PCR-based methods, for carcinogenic HPV types. We calculated positive and negative predictive values for the entire study period, and Kaplan-Meier estimates of cumulative probability for ≥CIN3, up to 18 years of follow-up.
  
  
  RESULTS
  We observed 47 cases of invasive cervical cancer during the study period, and 156 cases of CIN3. Predictive values and Kaplan-Meier analyses yielded the same conclusions. In women 30 and older, the reassurance against ≥CIN3 following a single negative HPV test was long-lasting (cumulative probability = 0.7% during follow-up). In this age group, a single HPV test (positive vs. negative, hazard ratio of 8.5, 95% CI = 4.8-15.1) provided greater long-term risk stratification than a single cytologic result (abnormal vs. normal, HR = 2.9, 95% CI = 1.2-6.6). The risk for ≥CIN3 was higher for HPV16 than for the average of the other carcinogenic types (hazard ratio = 2.7).
  
  
  CONCLUSIONS
  The data from this cohort study show the long-term predictive value of HPV testing, particularly in women ≥30, and a possible role for distinguishing particularly carcinogenic types like HPV16.
authors: Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892, USA.
authors: Mark
authors: M
authors: Schiffman
authors: Andrew G
authors: AG
authors: Glass
authors: Nicolas
authors: N
authors: Wentzensen
authors: Brenda B
authors: BB
authors: Rush
authors: Philip E
authors: PE
authors: Castle
authors: David R
authors: DR
authors: Scott
authors: Julie
authors: J
authors: Buckland
authors: Mark E
authors: ME
authors: Sherman
authors: Greg
authors: G
authors: Rydzak
authors: Peter
authors: P
authors: Kirk
authors: Attila T
authors: AT
authors: Lorincz
authors: Sholom
authors: S
authors: Wacholder
authors: Robert D
authors: RD
authors: Burk
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