Long-term follow-up of cervical disease in women screened by cytology and HPV testing: Results from the HART study

Abstract

Background:Several studies have shown that testing for high-risk human papillomavirus (HPV) types results in an improved sensitivity for CIN2+, compared with cytology, although with a somewhat lower specificity.Methods:We obtained follow-up results, with at least one smear after participation in the HART study, which compared HPV testing (HC-II) with cytology as a primary screening modality.Results:With a median follow-up of 6 years, 42 additional cases of CIN2 were identified; women who were HPV positive at baseline were more likely to develop CIN2 than those who were HPV negative (hazard ratio (HR) 17.2; 95% confidence interval (CI) (9.3-31.6)) and the risk increased with increasing viral load. Compared with HPV-negative women (relative light unit (RLU) 1), the HR (95% CI) was 5.4 (1.6, 18.2) for 1-10 RLU and 25.5 (13.6, 47.9) for RLU 10. Positive cytology (borderline or worse compared with negative) was also predictive of developing CIN2+, although to a lesser extent (HR 8.7; 95% CI (4.5-17.1)). Only one case of CIN3 and three cases of CIN2+ were found in women who showed a positive cytology result but were HPV negative at baseline.Conclusion:After 5 years of follow-up, CIN2+ occurred in 0.23% of women who were HPV negative at baseline compared with 0.48% of women who showed a negative cytology result, indicating a much longer low-risk interval for CIN2+ after HPV testing. © 2010 Cancer Research UK All rights reserved.