title: Cytology and human papillomavirus co-test results preceding incident high-grade cervical intraepithelial neoplasia.
abstract: OBJECTIVE
  High-risk HPV (hrHPV) and cytology co-testing is utilized for primary cervical cancer screening and for enhanced follow-up of women who are hrHPV-positive, cytology negative. However, data are lacking on the utility of this method to detect pre-cancer or cancer in community-based clinical practice. This study describes cytology and hrHPV results preceding high-grade cervical intraepithelial neoplasia, adenocarcinoma in situ, or cervical cancer (i.e., CIN2+) in an integrated health system employing routine co-testing among women aged 30 years and older.
  
  
  METHODS
  We conducted a cross-sectional analysis of adult female members of Kaiser Permanente Northern California (KPNC) with incident CIN2+ between July 2008 and June 2009. The primary outcome was the proportions of cytologic diagnoses and hrHPV co-test results preceding a diagnosis of CIN2+. Cervical cytology and hrHPV testing results were abstracted from electronic medical records.
  
  
  RESULTS
  Of 1283 CIN2+ cases among adult women, 880 (68.5%) were among women aged 30 years and older and 145/880 (16.5%, 95% CI 14.1-19.1) had only normal cytology during the 12 months prior to diagnosis. Furthermore, 133/880 (15.1%, 95% 12.9-17.7) were preceded by only normal cytology and persistent hrHPV infection (at least 2 positive hrHPV tests) during the 6-36 months preceding CIN2+ diagnosis.
  
  
  CONCLUSIONS
  Incident CIN2+ is frequently preceded by normal cytology and persistent hrHPV infection among women aged 30 years and older; screening strategies that employ HPV testing and cytology may improve the detection of CIN2+ compared with cytology alone.
authors: Sexually Transmitted Disease Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA, United States of America.
authors: Ina U
authors: IU
authors: Park
authors: University of California at Berkeley, Health and Medical Sciences, Berkeley, CA, United States of America.
authors: Nicole
authors: N
authors: Wojtal
authors: Kaiser Permanente Northern California Division of Research, Oakland, CA, United States of America.
authors: Michael J
authors: MJ
authors: Silverberg
authors: Sexually Transmitted Disease Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA, United States of America.
authors: Heidi M
authors: HM
authors: Bauer
authors: Kaiser Permanente Northern California Division of Research, Oakland, CA, United States of America.
authors: Leo B
authors: LB
authors: Hurley
authors: Kaiser Permanente Northern California Division of Research, Oakland, CA, United States of America.
authors: M Michele
authors: MM
authors: Manos
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D003710:Demography; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D060787:Neoplasm Grading; D027383:Papillomaviridae / Q000502:physiology*; D012307:Risk Factors; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000821:virology*