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The Correlation Between Human Papillomavirus Positivity and Abnormal Cervical Cytology Result Differs by Age Among Perimenopausal Women

Rositch, Anne F. PhD, MSPH1; Silver, Michelle I. MSc1; Burke, Anne MD, MPH2; Viscidi, Raphael MD3; Chang, Kathryn BS1; Duke, Cindy M.P. MD, PhD2; Shen, Wen MD, MPH2; Gravitt, Patti E. PhD, MS1,4,5

Journal of Lower Genital Tract Disease: January 2013 - Volume 17 - Issue 1 - p 38–47
doi: 10.1097/LGT.0b013e3182503402
Original Articles

Objectives We explored the age-stratified correlates and correlations between high-risk human papillomavirus (HR-HPV) infection and cervical abnormalities in perimenopausal women.

Materials and Methods Human papillomavirus testing and Pap smear screening were performed at baseline on 841 routinely screened women age 35 to 60 years in the HPV in perimenopause cohort. Demographic, behavioral, and medical information was collected through telephone-administered questionnaires. Descriptive analyses were used to examine the correlation between HR-HPV infection and cervical abnormalities by age. Logistic regression was used to determine correlates of HPV and abnormalities in women younger and older than 45 years.

Results The prevalence of HPV, HR-HPV, and cervical abnormalities decreased significantly with increasing age, as did the correlation between HR-HPV and cervical abnormalities. The prevalence of HR-HPV was 50% among younger women with abnormalities but this decreased steadily to 20% HR-HPV detection among 50- to 54-year-old women, and no abnormalities were detected in 55- to 60-year-old women. Different correlates of HR-HPV infection and abnormalities were observed in women 45 years or older, a pattern not seen in younger women.

Conclusions Although the relative proportion of low-grade and high-grade abnormalities did not change with age, we saw a loss of concordance between HR-HPV detection and cytological abnormalities with increasing age. Current guidelines for cervical cancer screening group together all women age 30 years and older. Our data raise important questions about the interpretation of HPV and Pap test results in this age group and suggest that ongoing surveillance of HPV and cytology in cervical cancer screening programs consider a third age stratification among older women.

Detection of high-risk human papillomavirus and cytological abnormalities decreased with age among women older than 35 years as did the correlation between these measures of risk of cervical precancer.

1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Departments of 2Gynecology and Obstetrics and 3Pediatrics, Johns Hopkins School of Medicine; 4W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and 5Graduate School of Medicine, Perdana University, Serdang, Selangor, Malaysia

Reprint requests to: Anne F. Rositch, PhD, MSPH, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6133, Baltimore, MD 21205. E-mail:

This work was supported by the US National Cancer Institute R01 CA123467 and the Institutional Research Cancer Epidemiology Fellowship funded by the National Cancer Institute T32 CA0009314. Dr Gravitt is a member of the Women’s Health Scientific Advisory Board for Qiagen. For the remaining authors, none was declared.

©2013The American Society for Colposcopy and Cervical Pathology