title: Long-term CIN3+ risk in women with abnormal cytology; role of hrHPV testing.
abstract: BACKGROUND
  Many studies have examined the short-term value of high-risk human papillomavirus (hrHPV) testing in predicting cumulative risk of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+). This study focuses on long-term CIN3+ risk after initial wait and see policy.
  
  
  METHODS
  A total of 342 women with abnormal cytology of borderline/mild dyskaryosis (BMD) or worse (>BMD), included between 1990 and 1992, were followed-up by cytology and hrHPV testing until 1996 and monitored by cytology thereafter. Primary endpoint was cumulative CIN3+ risk by December 2009.
  
  
  RESULTS
  Women with BMD had a 5-year CIN3+ risk of 22.5% (95% confidence interval (CI) 17.0-29.1) and of 0.7% (0.1-4.5) in the subsequent 5 years. High-risk human papillomavirus-negative women with BMD had a 5-year risk of <0.01% (95% CI 0.0-5.1) and of <0.01% (0.0-5.7) in the following 5 years, while for hrHPV-positive women these risks were 37.5% (29.0-46.9) and 1.6% (0.2-9.5), respectively. Women with >BMD had a 5-year risk of 45.1% (36.4-54.1) and of 3.5% (0.9-12.2) in the subsequent 5 years. High-risk human papillomavirus-negative women with >BMD had a 5-year risk of 7.3% (2.0-23.6) and hrHPV-positive women of 56.6% (46.4-66.3).
  
  
  CONCLUSIONS
  Women with BMD have an elevated CIN3+ risk for 5 years only; afterwards their risk is similar to the general population. High-risk human papillomavirus-negative women with BMD may return to regular screening directly. All other women with BMD should be referred for additional testing and/or colposcopy.
authors.affiliation: Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kocken
authors.forename: J
authors.initials: J
authors.lastname: Berkhof
authors.forename: F J
authors.initials: FJ
authors.lastname: van Kemenade
authors.forename: J A
authors.initials: JA
authors.lastname: Louwers
authors.forename: A
authors.initials: A
authors.lastname: Zaal
authors.forename: M A E
authors.initials: MA
authors.lastname: Nobbenhuis
authors.forename: G
authors.initials: G
authors.lastname: Kenter
authors.forename: P J F
authors.initials: PJ
authors.lastname: Snijders
authors.forename: C J L M
authors.initials: CJ
authors.lastname: Meijer
authors.forename: T J M
authors.initials: TJ
authors.lastname: Helmerhorst
mesh_terms: D000293:Adolescent; D000328:Adult; D052685:Alphapapillomavirus / Q000472:pathogenicity; D002584:Cervix Uteri / Q000473:pathology* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D012307:Risk Factors; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000821:virology