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Risk of Cervical Precancer and Cancer in Women Aged 30 Years and Older With an HPV-Negative Low-Grade Squamous Intraepithelial Lesion Screening Result

Littell, Ramey D. MD1; Kinney, Walter MD1; Fetterman, Barbara SCT (ASCP)2; Cox, J. Thomas MD3; Shaber, Ruth MD4; Poitras, Nancy ACS, PMP2; Lorey, Thomas MD2; Castle, Philip E. PhD, MPH5

Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e3181f2d659
Original Articles
Abstract

Objective. To characterize the 6- and 18-month cumulative risk of cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) and grade 3 or worse (CIN 3+) in women aged 30 years and older after a low-grade squamous intraepithelial lesion (LSIL) cytology and high-risk human papillomavirus (HPV)-negative screening result in routine clinical practice.

Materials and Methods. Comprehensive quality assurance databases of screening test and biopsy results from the Regional Laboratory of the Kaiser Permanente Northern California Health Plan were reviewed. All women aged 30 years and older with LSIL cytology were sorted by high-risk HPV status. Associated biopsy results were tabulated, and the corresponding risks of CIN 2+ and CIN 3+ diagnosed within 18 months after LSIL cytology were calculated overall and by decade of age.

Results. During the 6-year period, from 2003 to 2008, 4,113 LSIL cases were interpreted in women aged 30 years and older for which corresponding high-risk HPV and biopsy results were available. The proportion of women with LSIL testing positive for HPV declined with age, from 89% in the group aged 30 to 39 years to 76% in women older than 50 years (p < .001). Of 622 women with HPV-negative LSIL cytology, there was no case of cancer detected at colposcopy occurring within 6 months of the screening test. The 18-month risks of CIN 2+ and CIN 3+ were 3.5% and 1.4%, respectively.

Conclusions. The risk of CIN 3+ is sufficiently low in women aged 30 years and older with high-risk HPV-negative LSIL that 1 year follow-up rather than immediate colposcopy should be considered when it occurs in routine clinical practice.

In Brief

Risk of cancer in precancer associated with human papillomavirus-negative low-grade squamous intraepithelial lesion is sufficiently low to warrant management without immediate colposcopy

Author Information

1Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA; 2Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA; 3University of California Santa Barbara, Santa Barbara, CA; 4Women's Health Research Institute of Kaiser Permanente Northern California, Oakland, CA; and 5Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD

Correspondence to: Ramey D. Littell, MD, Division of Gynecologic Oncology, The Permanente Medical Group, 2238 Geary Blvd, San Francisco, CA 94115. E-mail: ramey.littell@kp.org

Dr Castle was supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health.These data were presented in part at the International Papillomavirus Society Meeting in Malmö, Sweden, May 8-14, 2009.

Dr Castle was supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health.

These data were presented in part at the International Papillomavirus Society Meeting in Malmö, Sweden, May 8-14, 2009.

©2011The American Society for Colposcopy and Cervical Pathology