Older women testing positive for HPV16/18 on cervical screening and risk of high‐grade cervical abnormality. Issue 8 (20th December 2022)

• Record Type: Journal Article
• Authors: Roberts, Jennifer Margaret; Machalek, Dorothy A.; Butler, Bethan C.; Crescini, Joanne; Garland, Suzanne M.; Farnsworth, Annabelle
• Is Part Of: International journal of cancer. Volume 152:Issue 8(2023)
• Page Start: 1593
• Page End: 1600
• Publication Date: 2022-12-20
• Subjects: cervical screening -- high‐grade abnormality -- human papillomavirus; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.34393
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: In Australia's HPV‐based cervical screening program, we previously showed that risk of histological high‐grade abnormality at 1 year post screening decreased with age in women with oncogenic HPV. In this study, we followed 878 HPV16/18 positive women aged 55 years and over for up to 3 years post screening test, to determine the proportion with histological high‐grade abnormality (HGA, incorporating high‐grade squamous intraepithelial abnormality (HSIL), adenocarcinoma in situ (AIS), squamous cell carcinoma (SCC) and adenocarcinoma) and to correlate risk of HGA with liquid‐based cytology result and with prior screening history. HGA was detected in 7.8% at 1 year and 10.0% at 3 years, with no significant difference ( P = .136), despite the number of women with follow‐up information significantly increasing from 82.9% to 91.0% ( P < .0001). The proportion of HPV16/18 positive women with HGA at 3 years was highest in those with an HSIL cytology result (79.0%) and lowest in those with negative cytology (6.2%). Women with an adequate screening history had fewer HGA than such women with inadequate prior screening (6.6% vs 16.0%, P = .001) or with a history of an abnormality (6.6% vs 14.4%, P = .001). HPV16/18 infection in women over 55 years may have a different natural history from that in younger women, in whom HGA are more common after HPV16/18 detection. In HPV‐based cervical screening programs, management algorithms for screen‐detected abnormalities based on risk stratification should include factors such as age, screening history and index cytology result, so that women receive appropriate investigation and follow‐up. Abstract : What's new? In one of the world's first human papillomavirus (HPV)‐based cervical cancer screening programs, analysis of outcomes for women over 55 testing positive for HPV16/18 showed that at 3 years, only 10% of women had a high‐grade intraepithelial lesion or carcinoma. Most high‐grade abnormalities were detected in the first year, and the risk was lowest among women with a negative screening history. The findings point to a different natural history of oncogenic HPV in older women, suggesting that algorithms for managing screening‐detected abnormalities based on risk stratification should include factors such as age and screening history.