Contribution of Etiologic Cofactors to CIN3+ Risk Among Women With Human Papillomavirus-Positive Screening Test Results

Maria Demarco; Didem Egemen; Noorie Hyun; Xiaojian Chen; Anna Barbara Moscicki; Li Cheung; Olivia Carter-Pokras; Anne Hammer; Julia C. Gage; Megan A. Clarke; Philip E. Castle; Brian Befano; Jie Chen; Cher Dallal; Xin He; Kanan Desai; Thomas Lorey; Nancy Poitras; Tina R. Raine-Bennett; Rebecca B. Perkins; Nicolas Wentzensen; Mark Schiffman

doi:10.1097/LGT.0000000000000667

Contribution of Etiologic Cofactors to CIN3+ Risk Among Women With Human Papillomavirus-Positive Screening Test Results

Maria Demarco
, Didem Egemen
, Noorie Hyun
, Xiaojian Chen
, Anna Barbara Moscicki
, Li Cheung
, Olivia Carter-Pokras
, Anne Hammer
, Julia C. Gage
, Megan A. Clarke
, Philip E. Castle
, Brian Befano
, Jie Chen
, Cher Dallal
, Xin He
, Kanan Desai
, Thomas Lorey
, Nancy Poitras
, Tina R. Raine-Bennett
, Rebecca B. Perkins

Nicolas Wentzensen, Mark Schiffman

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

10 Citations (Scopus)

Abstract

OBJECTIVE: The US screening and management guidelines for cervical cancer are based on the absolute risk of precancer estimated from large clinical cohorts and trials. Given the widespread transition toward screening with human papillomavirus (HPV) testing, it is important to assess which additional factors to include in clinical risk assessment to optimize management of HPV-infected women. MATERIALS AND METHODS: We analyzed data from HPV-infected women, ages 30-65 years, in the National Cancer Institute-Kaiser Permanente Northern California Persistence and Progression study. We estimated the influence of HPV risk group, cytology result, and selected cofactors on immediate risk of cervical intraepithelial neoplasia grade 3 or higher (CIN 3+) among 16,094 HPV-positive women. Cofactors considered included, age, race/ethnicity, income, smoking, and hormonal contraceptive use. RESULTS: Human papillomavirus risk group and cytology test result were strongly correlated with CIN 3+ risk. After considering cytology and HPV risk group, other cofactors (age, race/ethnicity, income, smoking, and hormonal contraceptive use) had minimal impact on CIN 3+ risk and did not change recommended management based on accepted risk thresholds. We had insufficient data to assess the impact of long-duration heavy smoking, parity, history of sexually transmitted infection, or immunosuppression. CONCLUSIONS: In our study at the Kaiser Permanente Northern California, the risk of CIN 3+ was determined mainly by HPV risk group and cytology results, with other cofactors having limited impact in adjusted analyses. This supports the use of HPV and cytology results in risk-based management guidelines.

Original language	English
Journal	Journal of Lower Genital Tract Disease
Volume	26
Issue	2
Pages (from-to)	127-134
Number of pages	8
ISSN	1089-2591
DOIs	https://doi.org/10.1097/LGT.0000000000000667
Publication status	Published - Apr 2022

Keywords

Adult
Aged
Alphapapillomavirus
Female
Humans
Mass Screening/methods
Middle Aged
Papillomaviridae
Papillomavirus Infections/diagnosis
Uterine Cervical Dysplasia/diagnosis
Uterine Cervical Neoplasms/diagnosis
Vaginal Smears

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10.1097/LGT.0000000000000667

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8940696/pdf/nihms-1776333.pdf

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Demarco, M., Egemen, D., Hyun, N., Chen, X., Moscicki, A. B., Cheung, L., Carter-Pokras, O., Hammer, A., Gage, J. C., Clarke, M. A., Castle, P. E., Befano, B., Chen, J., Dallal, C., He, X., Desai, K., Lorey, T., Poitras, N., Raine-Bennett, T. R., ... Schiffman, M. (2022). Contribution of Etiologic Cofactors to CIN3+ Risk Among Women With Human Papillomavirus-Positive Screening Test Results. Journal of Lower Genital Tract Disease, 26(2), 127-134. https://doi.org/10.1097/LGT.0000000000000667

@article{c4f2a727c7dd4b84be0de68722faf301,

title = "Contribution of Etiologic Cofactors to CIN3+ Risk Among Women With Human Papillomavirus-Positive Screening Test Results",

abstract = "OBJECTIVE: The US screening and management guidelines for cervical cancer are based on the absolute risk of precancer estimated from large clinical cohorts and trials. Given the widespread transition toward screening with human papillomavirus (HPV) testing, it is important to assess which additional factors to include in clinical risk assessment to optimize management of HPV-infected women. MATERIALS AND METHODS: We analyzed data from HPV-infected women, ages 30-65 years, in the National Cancer Institute-Kaiser Permanente Northern California Persistence and Progression study. We estimated the influence of HPV risk group, cytology result, and selected cofactors on immediate risk of cervical intraepithelial neoplasia grade 3 or higher (CIN 3+) among 16,094 HPV-positive women. Cofactors considered included, age, race/ethnicity, income, smoking, and hormonal contraceptive use. RESULTS: Human papillomavirus risk group and cytology test result were strongly correlated with CIN 3+ risk. After considering cytology and HPV risk group, other cofactors (age, race/ethnicity, income, smoking, and hormonal contraceptive use) had minimal impact on CIN 3+ risk and did not change recommended management based on accepted risk thresholds. We had insufficient data to assess the impact of long-duration heavy smoking, parity, history of sexually transmitted infection, or immunosuppression. CONCLUSIONS: In our study at the Kaiser Permanente Northern California, the risk of CIN 3+ was determined mainly by HPV risk group and cytology results, with other cofactors having limited impact in adjusted analyses. This supports the use of HPV and cytology results in risk-based management guidelines.",

keywords = "Adult, Aged, Alphapapillomavirus, Female, Humans, Mass Screening/methods, Middle Aged, Papillomaviridae, Papillomavirus Infections/diagnosis, Uterine Cervical Dysplasia/diagnosis, Uterine Cervical Neoplasms/diagnosis, Vaginal Smears",

author = "Maria Demarco and Didem Egemen and Noorie Hyun and Xiaojian Chen and Moscicki, \{Anna Barbara\} and Li Cheung and Olivia Carter-Pokras and Anne Hammer and Gage, \{Julia C.\} and Clarke, \{Megan A.\} and Castle, \{Philip E.\} and Brian Befano and Jie Chen and Cher Dallal and Xin He and Kanan Desai and Thomas Lorey and Nancy Poitras and Raine-Bennett, \{Tina R.\} and Perkins, \{Rebecca B.\} and Nicolas Wentzensen and Mark Schiffman",

year = "2022",

month = apr,

doi = "10.1097/LGT.0000000000000667",

language = "English",

volume = "26",

pages = "127--134",

journal = "Journal of Lower Genital Tract Disease",

issn = "1089-2591",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "2",

}

Demarco, M, Egemen, D, Hyun, N, Chen, X, Moscicki, AB, Cheung, L, Carter-Pokras, O, Hammer, A, Gage, JC, Clarke, MA, Castle, PE, Befano, B, Chen, J, Dallal, C, He, X, Desai, K, Lorey, T, Poitras, N, Raine-Bennett, TR, Perkins, RB, Wentzensen, N & Schiffman, M 2022, 'Contribution of Etiologic Cofactors to CIN3+ Risk Among Women With Human Papillomavirus-Positive Screening Test Results', Journal of Lower Genital Tract Disease, vol. 26, no. 2, pp. 127-134. https://doi.org/10.1097/LGT.0000000000000667

Contribution of Etiologic Cofactors to CIN3+ Risk Among Women With Human Papillomavirus-Positive Screening Test Results. / Demarco, Maria; Egemen, Didem; Hyun, Noorie et al.
In: Journal of Lower Genital Tract Disease, Vol. 26, No. 2, 04.2022, p. 127-134.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Contribution of Etiologic Cofactors to CIN3+ Risk Among Women With Human Papillomavirus-Positive Screening Test Results

AU - Demarco, Maria

AU - Egemen, Didem

AU - Hyun, Noorie

AU - Chen, Xiaojian

AU - Moscicki, Anna Barbara

AU - Cheung, Li

AU - Carter-Pokras, Olivia

AU - Hammer, Anne

AU - Gage, Julia C.

AU - Clarke, Megan A.

AU - Castle, Philip E.

AU - Befano, Brian

AU - Chen, Jie

AU - Dallal, Cher

AU - He, Xin

AU - Desai, Kanan

AU - Lorey, Thomas

AU - Poitras, Nancy

AU - Raine-Bennett, Tina R.

AU - Perkins, Rebecca B.

AU - Wentzensen, Nicolas

AU - Schiffman, Mark

PY - 2022/4

Y1 - 2022/4

N2 - OBJECTIVE: The US screening and management guidelines for cervical cancer are based on the absolute risk of precancer estimated from large clinical cohorts and trials. Given the widespread transition toward screening with human papillomavirus (HPV) testing, it is important to assess which additional factors to include in clinical risk assessment to optimize management of HPV-infected women. MATERIALS AND METHODS: We analyzed data from HPV-infected women, ages 30-65 years, in the National Cancer Institute-Kaiser Permanente Northern California Persistence and Progression study. We estimated the influence of HPV risk group, cytology result, and selected cofactors on immediate risk of cervical intraepithelial neoplasia grade 3 or higher (CIN 3+) among 16,094 HPV-positive women. Cofactors considered included, age, race/ethnicity, income, smoking, and hormonal contraceptive use. RESULTS: Human papillomavirus risk group and cytology test result were strongly correlated with CIN 3+ risk. After considering cytology and HPV risk group, other cofactors (age, race/ethnicity, income, smoking, and hormonal contraceptive use) had minimal impact on CIN 3+ risk and did not change recommended management based on accepted risk thresholds. We had insufficient data to assess the impact of long-duration heavy smoking, parity, history of sexually transmitted infection, or immunosuppression. CONCLUSIONS: In our study at the Kaiser Permanente Northern California, the risk of CIN 3+ was determined mainly by HPV risk group and cytology results, with other cofactors having limited impact in adjusted analyses. This supports the use of HPV and cytology results in risk-based management guidelines.

AB - OBJECTIVE: The US screening and management guidelines for cervical cancer are based on the absolute risk of precancer estimated from large clinical cohorts and trials. Given the widespread transition toward screening with human papillomavirus (HPV) testing, it is important to assess which additional factors to include in clinical risk assessment to optimize management of HPV-infected women. MATERIALS AND METHODS: We analyzed data from HPV-infected women, ages 30-65 years, in the National Cancer Institute-Kaiser Permanente Northern California Persistence and Progression study. We estimated the influence of HPV risk group, cytology result, and selected cofactors on immediate risk of cervical intraepithelial neoplasia grade 3 or higher (CIN 3+) among 16,094 HPV-positive women. Cofactors considered included, age, race/ethnicity, income, smoking, and hormonal contraceptive use. RESULTS: Human papillomavirus risk group and cytology test result were strongly correlated with CIN 3+ risk. After considering cytology and HPV risk group, other cofactors (age, race/ethnicity, income, smoking, and hormonal contraceptive use) had minimal impact on CIN 3+ risk and did not change recommended management based on accepted risk thresholds. We had insufficient data to assess the impact of long-duration heavy smoking, parity, history of sexually transmitted infection, or immunosuppression. CONCLUSIONS: In our study at the Kaiser Permanente Northern California, the risk of CIN 3+ was determined mainly by HPV risk group and cytology results, with other cofactors having limited impact in adjusted analyses. This supports the use of HPV and cytology results in risk-based management guidelines.

KW - Adult

KW - Aged

KW - Alphapapillomavirus

KW - Female

KW - Humans

KW - Mass Screening/methods

KW - Middle Aged

KW - Papillomaviridae

KW - Papillomavirus Infections/diagnosis

KW - Uterine Cervical Dysplasia/diagnosis

KW - Uterine Cervical Neoplasms/diagnosis

KW - Vaginal Smears

UR - https://www.scopus.com/pages/publications/85127999972

U2 - 10.1097/LGT.0000000000000667

DO - 10.1097/LGT.0000000000000667

M3 - Journal article

C2 - 35249974

AN - SCOPUS:85127999972

SN - 1089-2591

VL - 26

SP - 127

EP - 134

JO - Journal of Lower Genital Tract Disease

JF - Journal of Lower Genital Tract Disease

IS - 2

ER -

Contribution of Etiologic Cofactors to CIN3+ Risk Among Women With Human Papillomavirus-Positive Screening Test Results

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