Age‐stratified 5‐year risks of cervical precancer among women with enrollment and newly detected HPV infection

• Published in: International journal of cancer Vol. 136; no. 7; pp. 1665 - 1671
• Main Authors: Gage, Julia C., Katki, Hormuzd A., Schiffman, Mark, Fetterman, Barbara, Poitras, Nancy E., Lorey, Thomas, Cheung, Li C., Castle, Philip E., Kinney, Walter K.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.04.2015
• Subjects: Adult; age; Age Factors; Alphapapillomavirus; Cancer; cancer prevention; Cervical cancer; cervical intraepithelial neoplasia; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - epidemiology; Cervical Intraepithelial Neoplasia - etiology; Cohort Studies; cytology; Early Detection of Cancer; Female; Human Papillomavirus; Humans; hybrid capture 2; Mass Screening; Medical research; Middle Aged; Neoplasm Grading; Papanicolaou Test; Papillomavirus Infections - complications; Papillomavirus Infections - diagnosis; Papillomavirus Infections - epidemiology; Precancerous Conditions; Risk; Sexually transmitted diseases; STD; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - etiology; Vaginal Smears; Women; cytology; Human Papillomavirus; cancer prevention; age; cervical intraepithelial neoplasia; hybrid capture 2
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.29143

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. What's new? Screening for human papillomavirus (HPV) is typically targeted at older women, in whom persistent HPV infection is linked to progression to cervical neoplasia and cancer. However, it is unclear whether a woman's age influences her risk of progression following HPV detection. Here, women ages 30 to 64 who were HPV‐positive at enrollment in an HPV and Pap co‐testing screening program were discovered to have a higher 5‐year risk of cervical precancer and cancer than women with newly detected HPV infection. However, HPV infection rates declined with age, and associated risks did not rise with increasing age.