Long-term follow-up of cervical abnormalities among women screened by HPV testing and cytology—Results from the Hammersmith study

Authors

  • Jack Cuzick,

    Corresponding author
    1. Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London, United Kingdom
    • Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London EC1M, 6BQ, UK
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    • Fax: +44-20-7014-0269

  • Anne Szarewski,

    1. Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London, United Kingdom
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  • David Mesher,

    1. Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London, United Kingdom
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  • Louise Cadman,

    1. Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London, United Kingdom
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  • Janet Austin,

    1. Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London, United Kingdom
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  • Karen Perryman,

    1. Department of Gynaecological Oncology, Hammersmith Hospital, London, United Kingdom
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  • Linda Ho,

    1. Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London, United Kingdom
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  • George Terry,

    1. Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London, United Kingdom
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  • Peter Sasieni,

    1. Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London, United Kingdom
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  • Roberto Dina,

    1. Department of Histopathology, Hammersmith Hospital, Du Cane Road, London, W12 OHS, United Kingdom
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  • William P. Soutter

    1. Department of Gynaecological Oncology, Hammersmith Hospital, London, United Kingdom
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  • Conflict of Interest: Jack Cuzick serves on the speaker's bureau for Digene Corporation and the advisory board for Roche Molecular Systems and the department has received research funding from Digene Corporation, Roche, MTM, Norchip, Genprobe and GlaxoSmithKline.

Abstract

Several studies have shown that HPV testing is substantially more sensitive than cytology for primary cervical screening. However, less data exist concerning the duration of protection afforded by a negative HPV test compared to a normal cytological outcome. Here we report the long-term findings from the Hammersmith study in women aged 35 or more. HPV testing by Hybrid Capture II was performed on all available samples from the baseline screening visit. Passive surveillance of subsequent cytology screening results for the 2,982 women in the study was undertaken using a national registry. Histological outcomes were sought for all women with abnormal smears. The primary outcome was duration of protection against histologically confirmed CIN2+ afforded by a negative HPV test compared to normal cytology. 2,516 women had at least one further smear at least 1 year after entry and 20 new cases of CIN2+ were identified during a median follow-up of 6.4 years. Including disease identified at baseline, the risk of developing CIN2+ at 1, 5 and 9 years after a normal cytology was 0.33%, 0.83% and 2.20% respectively whereas it was 0.19%, 0.42% and 1.88% after a negative HPV test. HPV testing offered excellent protection from CIN2+ for at least 6 years after a negative test, whereas the protection from cytology began to wane after about 3 years. Substantially more CIN2+ lesions were found in the follow-up period in those initially HPV positive compared to those HPV negative (HR = 6.52, p = 0.001), whereas there was little difference according to initial cytology (HR = 1.64, p = 0.51). © 2008 Wiley-Liss, Inc.

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