title: Age-stratified 5-year risks of cervical precancer among women with enrollment and newly detected HPV infection.
abstract: It is unclear whether a woman's age influences her risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) upon detection of HPV. A large change in risk as women age would influence vaccination and screening policies. Among 972,029 women age 30-64 undergoing screening with Pap and HPV testing (Hybrid Capture 2, Qiagen, Germantown, MD) at Kaiser Permanente Northern California (KPNC), we calculated age-specific 5-year CIN3+ risks among women with HPV infections detected at enrollment, and among women with "newly detected" HPV infections at their second screening visit. Women (57,899, 6.0%) had an enrollment HPV infection. Among the women testing HPV negative at enrollment with a second screening visit, 16,724 (3.3%) had a newly detected HPV infection at their second visit. Both enrollment and newly detected HPV rates declined with age (p < 0.001). Women with enrollment versus newly detected HPV infection had higher 5-year CIN3+ risks: 8.5% versus 3.9%, (p < 0.0001). Risks did not increase with age but declined slightly from 30-34 years to 60-64 years: 9.4% versus 7.4% (p = 0.017) for enrollment HPV and 5.1% versus 3.5% (p = 0.014) for newly detected HPV. Among women age 30-64 in an established screening program, women with newly detected HPV infections were at lower risk than women with enrollment infections, suggesting reduced benefit vaccinating women at older ages. Although the rates of HPV infection declined dramatically with age, the subsequent CIN3+ risks associated with HPV infection declined only slightly. The CIN3+ risks among older women are sufficiently elevated to warrant continued screening through age 65.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Gage
authors.forename: Hormuzd A
authors.initials: HA
authors.lastname: Katki
authors.forename: Mark
authors.initials: M
authors.lastname: Schiffman
authors.forename: Barbara
authors.initials: B
authors.lastname: Fetterman
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Poitras
authors.forename: Thomas
authors.initials: T
authors.lastname: Lorey
authors.forename: Li C
authors.initials: LC
authors.lastname: Cheung
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kinney
mesh_terms: D000328:Adult; D000367:Age Factors; D052685:Alphapapillomavirus; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D060787:Neoplasm Grading; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D011230:Precancerous Conditions; D012306:Risk; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology
keywords: Human Papillomavirus; age; cancer prevention; cervical intraepithelial neoplasia; cytology; hybrid capture 2