title: Long-term risk of recurrent cervical human papillomavirus infection and precancer and cancer following excisional treatment.
abstract: Risk of recurrent CIN2+ (including cervical intraepithelial neoplasia grade 2 [CIN2], CIN3, carcinoma and in situ, adenocarcinoma in situ or cancer) remains elevated for years following treatment. The role of long-term post-treatment human papillomavirus (HPV) presence on subsequent risk of CIN2+ was evaluated in the 10,049-women Guanacaste cohort. Six hundred eighty-one women were referred to colposcopy because of high-grade cytology, positive cervicography and/or suspicion of cancer based on visual assessment; 486 were judged to require treatment. After excluding women with <12 months of follow-up (N = 88), prior cancer or hysterectomy (N = 37) or other reasons (N = 14), 347 were included in the analysis. Infections were categorized as persistent if present at both pre- and post-treatment visits and new if detected only post-treatment. Median time between the treatment and post-treatment visits was 6.7 years (interquartile range 3.8-7.8). At the post-treatment visit, 8 (2.4%), 2 (0.6%) and 8 (2.4%) of the 347 treated women had persistent HPV16, HPV18 or other carcinogenic HPV, respectively. Two (0.8%), 3 (1.0%) and 13 (4.0%) had new HPV16, HPV18 and other carcinogenic HPV, respectively. Six CIN2+ cases were identified at the post-treatment visit, all with persistent infections (three HPV16, one HPV18 and two other carcinogenic HPV). No recurrent disease was observed among women with new HPV infections during the follow-up period. Thus, persistence of HPV infection a median of six years after treatment was uncommon but, when present, posed a substantial risk of subsequent CIN2+. Serial follow-up data from other studies would further strengthen these conclusions.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Rockville, MD, USA.
authors.forename: Aimée R
authors.initials: AR
authors.lastname: Kreimer
authors.forename: Mark
authors.initials: M
authors.lastname: Schiffman
authors.forename: Rolando
authors.initials: R
authors.lastname: Herrero
authors.forename: Allan
authors.initials: A
authors.lastname: Hildesheim
authors.forename: Paula
authors.initials: P
authors.lastname: González
authors.forename: Robert D
authors.initials: RD
authors.lastname: Burk
authors.forename: Carolina
authors.initials: C
authors.lastname: Porras
authors.forename: Mark E
authors.initials: ME
authors.lastname: Sherman
authors.forename: Franklin
authors.initials: F
authors.lastname: Demuth
authors.forename: Li
authors.initials: L
authors.lastname: Cheung
authors.forename: Concepción
authors.initials: C
authors.lastname: Bratti
authors.forename: Ana
authors.initials: A
authors.lastname: Cecilia Rodríguez
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000601:surgery* / Q000821:virology; D015331:Cohort Studies; D003127:Colposcopy; D005260:Female; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D052161:Human papillomavirus 18 / Q000302:isolation & purification; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D030361:Papillomavirus Infections / Q000821:virology*; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery* / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery* / Q000821:virology