title: Risk of high-grade precancerous lesions and invasive cancers in high-risk HPV-positive women with normal cervix or CIN 1 at baseline-A population-based cohort study.
abstract: Infection with high-risk human papillomavirus (HR-HPV) is transient and clears on its own in majority of the women. Only a few women who have persistent infection may finally develop cervical intraepithelial neoplasia (CIN) or cervical cancer in later years. The risk of progression in the HR-HPV-positive women with normal cervix or low-grade lesion on colposcopy and histopathology at baseline is less studied. We performed a longitudinal study on 650 HR-HPV-positive women with colposcopy and/or histopathology-proved normal or CIN1 diagnosis at baseline to assess the cumulative risk of development of high-grade CIN. After a mean follow-up of 2.1 person years of observation (PYO) (range 0.1-5.1), the cumulative incidence of CIN2+ (6.4%; 3.0/100 PYO) was significantly higher in women who had persistent HR-HPV infection compared to those who cleared the infection (adjusted HR 6.28; 95% CI 2.87-13.73). The risk of viral persistence in women aged 50-60 years was two times higher compared to women aged 40-49 years and three times higher compared to women aged 30-39 years. The probability of having persistent infection increased progressively with higher viral load at baseline (adjusted HR 3.29, 95% CI 2.21-4.90 for RLU ≥100; adjusted HR 2.69, 95% CI 1.71-4.22 for RLU 10-100). Women with increasing viral load at follow-up had four times higher risk of developing CIN2 or worse lesions as compared to those with decreasing load (20.9% vs 4.8%; p < 0.001). In the context of developing countries where cytology or genotyping triaging is not feasible, colposcopy referral of HR-HPV-positive women with advancing age, viral persistence, and increasing viral load may be considered.
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Srabani
authors.initials: S
authors.lastname: Mittal
authors.affiliation: Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
authors.forename: Partha
authors.initials: P
authors.lastname: Basu
authors.affiliation: Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Muwonge
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Dipanwita
authors.initials: D
authors.lastname: Banerjee
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Ishita
authors.initials: I
authors.lastname: Ghosh
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Mitali Mukherjee
authors.initials: MM
authors.lastname: Sengupta
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Pradip
authors.initials: P
authors.lastname: Das
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Priatosh
authors.initials: P
authors.lastname: Dey
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Ranajit
authors.initials: R
authors.lastname: Mandal
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Chinmay
authors.initials: C
authors.lastname: Panda
authors.affiliation: Chittaranjan National Cancer Institute, Kolkata, West Bengal, India.
authors.forename: Jaydip
authors.initials: J
authors.lastname: Biswas
authors.affiliation: Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
authors.forename: Rengaswamy
authors.initials: R
authors.lastname: Sankaranarayanan
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology*; D003127:Colposcopy; D005260:Female; D005838:Genotype; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D011247:Pregnancy; D012307:Risk Factors; D014626:Vaginal Smears; D019562:Viral Load; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000821:virology
keywords: cervical intraepithelial neoplasia; cumulative risk; high-risk human papillomavirus; hybrid capture II; viral load