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. 2016 Dec 1;122(23):3682-3686.
doi: 10.1002/cncr.30277. Epub 2016 Sep 22.

The population impact of human papillomavirus/cytology cervical cotesting at 3-year intervals: Reduced cervical cancer risk and decreased yield of precancer per screen

Michelle I Silver  1 , Mark Schiffman  1 , Barbara Fetterman  2 , Nancy E Poitras  2 , Julia C Gage  1 , Nicolas Wentzensen  1 , Thomas Lorey  2 , Walter K Kinney  3 , Philip E Castle  4
Affiliations

The population impact of human papillomavirus/cytology cervical cotesting at 3-year intervals: Reduced cervical cancer risk and decreased yield of precancer per screen

Michelle I Silver et al. Cancer. .

Abstract

Background: The objective of cervical screening is to detect and treat precancer to prevent cervical cancer mortality and morbidity while minimizing overtreatment of benign human papillomavirus (HPV) infections and related minor abnormalities. HPV/cytology cotesting at extended 5-year intervals currently is a recommended screening strategy in the United States, but the interval extension is controversial. In the current study, the authors examined the impact of a decade of an alternative, 3-year cotesting, on rates of precancer and cancer at Kaiser Permanente Northern California. The effect on screening efficiency, defined as numbers of cotests/colposcopy visits needed to detect a precancer, also was considered.

Methods: Two cohorts were defined. The "open cohort" included all women screened at least once during the study period; > 1 million cotests were performed. In a fixed "long-term screening cohort," the authors considered the cumulative impact of repeated screening at 3-year intervals by restricting the cohort to women first cotested in 2003 through 2004 (ie, no women entering screening later were added to this group).

Results: Detection of cervical intraepithelial neoplasia 3/adenocarcinoma in situ (CIN3/AIS) increased in the open cohort (2004-2006: 82.0/100,000 women screened; 2007-2009: 140.6/100,000 women screened; and 2010-2012: 126.0/100,000 women screened); cancer diagnoses were unchanged. In the long-term screening cohort, the detection of CIN3/AIS increased and then decreased to the original level (2004-2006: 80.5/100,000 women screened; 2007-2009: 118.6/100,000 women screened; and 2010-2012: 84.9./100,000 women screened). The number of cancer diagnoses was found to decrease. When viewed in terms of screening efficiency, the number of colposcopies performed to detect a single case of CIN3/AIS increased in the cohort with repeat screening.

Conclusions: Repeated cotesting at a 3-year interval eventually lowers population rates of precancer and cancer. However, a greater number of colposcopies are required to detect a single precancer. Cancer 2016;122:3682-6. © 2016 American Cancer Society.

Keywords: biopsy; cervical cancer; cervical intraepithelial neoplasia; colposcopy; cotest; human papillomavirus; screening.

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Conflict of interest statement

Gage JC has received HPV testing at no cost for research from Roche and BD; Schiffman M declared that NCI has received testing of specimens at no cost for independent evaluation of HPV typing from Roche and BD; and Wentzensen N declared that NCI has received free reagents from BD, Roche and Hologic for his studies. Castle PE has received commercial HPV tests for research at a reduced or no cost from Roche, QIAGEN, Norchip, and MTM. He is a paid consultant for BD, GE Healthcare, Roche, Gen-Probe/Hologic, and Cepheid. He is compensated as a member of a Merck Data and Safety Monitoring Board for HPV vaccines.

Comment in

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