Human papillomavirus type specific risk of progression and remission during long‐term follow‐up of equivocal and low‐grade HPV‐positive cervical smears

• Published in: International journal of cancer Vol. 143; no. 4; pp. 851 - 860
• Main Authors: Vintermyr, Olav Karsten, Andersland, Marie Songstad, Bjørge, Tone, Skar, Robert, Iversen, Ole Erik, Nygård, Mari, Haugland, Hans Kristian
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.08.2018
• Subjects: Adult; Aged; Alphapapillomavirus - isolation & purification; Alphapapillomavirus - pathogenicity; ASCUS; Cancer; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - virology; CIN2; Disease Progression; Early Detection of Cancer; Female; Follow-Up Studies; Health risk assessment; HPV types; Human papillomavirus; Humans; Infections; Lesions; LSIL; Medical research; Middle Aged; Norway; Papanicolaou Test; Papillomavirus Infections - diagnosis; Papillomavirus Infections - pathology; Prevalence; progression risk; Prospective Studies; Remission; Remission Induction; Risk groups; Squamous cells; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - virology; Vaginal Smears; Norway; LSIL; progression risk; HPV types; ASCUS; CIN2
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.31390

The prevalence of clinically relevant HPV types and their specific risk for progression and regression in women with atypical squamous cells of uncertain significance (ASCUS) and low‐grade squamous intraepithelial lesions (LSIL) were studied in a routine screening population. A 4‐year cohort of women (n = 820) with ASCUS/LSIL and a positive HPV test in triage were followed for 6–9 years. The progression risks for CIN2+/CIN3+ were determined for single (71.2%) and multiple HPV infections (28.8%). The CIN2+ progression risk for all HPV 16, all HPV 35, single HPV 16 and single HPV 35 infections were 65.3% (95% CI: 59.6–71.0), 64.4% (95% CI: 50.4–78.4), 63.8% (95% CI: 56.2–71.4) and 73.7% (95% CI: 53.9–93.5), respectively. Based on CIN2+ progression risks four main groups were defined; the HPV 16 group, the HPV 31/33/35 group, the HPV 18/45/51/52 group and the HPV 39/56/58/59/66/68 group with progression risks of 65.3% (95% CI: 59.6–71.0), 62.1% (95% CI: 54.8–69.4), 52.6 (95% CI: 45.9–59.3) and 39.5 (95% CI: 33.0–46.0), respectively. In multivariate analyses, women in the age group 40–49 years had an increased risk of CIN2+ progression. As for CIN3+, HPV 16 had a higher progression risk than other HPV risk groups (p < 0.05). In multiple infections only HPV 16 had a significant additive CIN3+ progression risk (p < 0.05) as compared to other HPV risk groups. In summary, HPV types 16 and 35, including the HPV risk group 31/33/35, had a similar CIN2+ progression risk, but only HPV 16 had a higher risk for CIN3+ progression. What's new? While it is known that infection with human papilloma virus (HPV) type 16 can lead to highest‐grade cervical intraepithelial neoplasia (CIN3+), the HPV types associated with progression to the less dysplastic CIN2+ stage are less well studied. Here the authors analyzed data from a national screening program in Norway and found that HPV35, along with HPV31 and 33, was quite common with a CIN2+ progression risk similar to HPV16. However, HPV16 had the strongest association with progression to CIN3+, underscoring the heterogeneity observed in the CIN2+ progression risk group.