title: Reassurance against future risk of precancer and cancer conferred by a negative human papillomavirus test.
abstract: Primary human papillomavirus (HPV) testing (without concurrent Pap tests) every 3 years is under consideration in the United States as an alternative to the two recommended cervical cancer screening strategies: primary Pap testing every 3 years, or concurrent Pap and HPV testing ("cotesting") every 5 years. Using logistic regression and Weibull survival models, we estimated and compared risks of cancer and cervical intraepithelial neoplasia grade 3 or worse (CIN3+) for the three strategies among 1011092 women aged 30 to 64 years testing HPV-negative and/or Pap-negative in routine screening at Kaiser Permanente Northern California since 2003. All statistical tests were two sided. Three-year risks following an HPV-negative result were lower than 3-year risks following a Pap-negative result (CIN3+ = 0.069% vs 0.19%, P < .0001; Cancer = 0.011% vs 0.020%, P < .0001) and 5-year risks following an HPV-negative/Pap-negative cotest (CIN3+ = 0.069% vs 0.11%, P < .0001; Cancer = 0.011% vs 0.014%, P = .21). These findings suggest that primary HPV testing merits consideration as another alternative for cervical screening.
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (JCG, MS, HAK, NW); Global Cancer Initiative, Chestertown, MD (PEC); Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA (BF, NEP, TL); Information Management Services Inc., Calverton, MD (LCC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WKK). gagej@mail.nih.gov.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Gage
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (JCG, MS, HAK, NW); Global Cancer Initiative, Chestertown, MD (PEC); Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA (BF, NEP, TL); Information Management Services Inc., Calverton, MD (LCC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WKK).
authors.forename: Mark
authors.initials: M
authors.lastname: Schiffman
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (JCG, MS, HAK, NW); Global Cancer Initiative, Chestertown, MD (PEC); Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA (BF, NEP, TL); Information Management Services Inc., Calverton, MD (LCC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WKK).
authors.forename: Hormuzd A
authors.initials: HA
authors.lastname: Katki
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (JCG, MS, HAK, NW); Global Cancer Initiative, Chestertown, MD (PEC); Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA (BF, NEP, TL); Information Management Services Inc., Calverton, MD (LCC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WKK).
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (JCG, MS, HAK, NW); Global Cancer Initiative, Chestertown, MD (PEC); Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA (BF, NEP, TL); Information Management Services Inc., Calverton, MD (LCC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WKK).
authors.forename: Barbara
authors.initials: B
authors.lastname: Fetterman
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (JCG, MS, HAK, NW); Global Cancer Initiative, Chestertown, MD (PEC); Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA (BF, NEP, TL); Information Management Services Inc., Calverton, MD (LCC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WKK).
authors.forename: Nicolas
authors.initials: N
authors.lastname: Wentzensen
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (JCG, MS, HAK, NW); Global Cancer Initiative, Chestertown, MD (PEC); Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA (BF, NEP, TL); Information Management Services Inc., Calverton, MD (LCC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WKK).
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Poitras
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (JCG, MS, HAK, NW); Global Cancer Initiative, Chestertown, MD (PEC); Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA (BF, NEP, TL); Information Management Services Inc., Calverton, MD (LCC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WKK).
authors.forename: Thomas
authors.initials: T
authors.lastname: Lorey
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (JCG, MS, HAK, NW); Global Cancer Initiative, Chestertown, MD (PEC); Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA (BF, NEP, TL); Information Management Services Inc., Calverton, MD (LCC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WKK).
authors.forename: Li C
authors.initials: LC
authors.lastname: Cheung
authors.affiliation: Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (JCG, MS, HAK, NW); Global Cancer Initiative, Chestertown, MD (PEC); Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA (BF, NEP, TL); Information Management Services Inc., Calverton, MD (LCC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WKK).
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kinney
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D055088:Early Detection of Cancer / Q000379:methods / Q000639:trends; D005260:Female; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods / Q000639:trends; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications* / Q000175:diagnosis*; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000821:virology; D011237:Predictive Value of Tests; D015397:Program Evaluation; D018570:Risk Assessment; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology