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. 2010 Apr 27;102(9):1405-10.
doi: 10.1038/sj.bjc.6605619. Epub 2010 Mar 30.

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

D Mesher  1 , A Szarewski, L Cadman, H Cubie, H Kitchener, D Luesley, U Menon, G Hulman, M Desai, L Ho, G Terry, A Williams, P Sasieni, J Cuzick
Affiliations

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

D Mesher et al. Br J Cancer. .

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 > or = 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.

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Figures

Figure 1
Figure 1
The HART trial profile. *Includes 1 woman who had hgd at baseline and during follow-up. **53 women had no adequate Cytology within one year of baseline.
Figure 2
Figure 2
Cumulative incidence of CIN2+ in the follow-up period according to baseline results.
Figure 3
Figure 3
Cumulative incidence of CIN2+ according to baseline results.
See this image and copyright information in PMC

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