High-risk and low-risk human papillomavirus and the absolute risk of cervical intraepithelial neoplasia or cancer.
OBJECTIVE
To determine the absolute risk of cervical intraepithelial neoplasia (CIN) grade 3 or cervical cancer (CIN 3 or worse) after detection of low-risk human papillomavirus (HPV) and after a negative high-risk HPV test.


METHODS
In this prospective cohort study, consecutive liquid-based cervical cytology samples were collected from women screened for cervical cancer in Copenhagen, Denmark, during 2002-2005. Samples were tested with a clinical test for 13 high-risk and five low-risk HPV types. The cohort (N=35,539; aged 14-90 years) was monitored in a nationwide pathology register for up to 10.5 years for development of CIN 3 or worse.


RESULTS
The 8-year absolute risk of CIN 3 or worse was 1.1% (95% confidence interval [CI] 1.0-1.3%) for HPV-negative women; 1.7% (0.8-2.6%) for low-risk HPV-positive women without concurrent high-risk HPV; 17.4% (16.4-18.5%) for high-risk HPV-positive women without concurrent low-risk HPV; and 15.9% (13.5-18.3%) for women with concurrent high-risk and low-risk HPV. The 8-year absolute risk of CIN 3 or worse after a negative high-risk HPV test (irrespective of low-risk HPV status) was lower than after a normal cytology result among women aged younger than 30 years (3.5% [95% CI, 2.9-4.0%] compared with 6.9% [6.2-7.5%], P<.001) and women aged 30 years or older (0.7% [95% CI, 0.6-0.9%] compared with 1.8% [95% CI, 1.6-2.0%], P<.001).


CONCLUSIONS
A negative high-risk HPV test provides greater long-term reassurance against CIN 3 or worse than normal cytology. Detection of low-risk HPV does not predict CIN 3 or worse. Cervical cancer screening should not include testing for low-risk HPV types.


METHODS
II.
Unit of Virus, Lifestyle and Genes and Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, and the Gynecologic Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, and the Department of Pathology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark; the Global Cancer Initiative, Chestertown, Maryland; and the University Hospital of Tübingen, Section of Experimental Virology, Tübingen, Germany.
Louise T
LT
Thomsen
Kirsten
K
Frederiksen
Christian
C
Munk
Jette
J
Junge
Philip E
PE
Castle
Thomas
T
Iftner
Susanne K
SK
Kjaer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000473:pathology*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics*; D011446:Prospective Studies; D018570:Risk Assessment; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000821:virology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000821:virology*