Clare Gilham (United Kingdom)
London School of Hygiene and Tropical Medicine Epidemiology and Population HealthPresenter of 2 Presentations
TRIAGING HPV POSITIVE WOMEN WITH LOW-GRADE CYTOLOGY: EVIDENCE FROM 10 YEAR FOLLOW-UP OF THE ARTISTIC TRIAL COHORT (ID 1069)
Webcast
LONG-TERM CERVICAL CANCER RISK FOLLOWING HPV INFECTION – 28 YEAR FOLLOW-UP OF THE MANCHESTER COHORT (ID 1275)
Abstract
Introduction
The natural history of HPV infection and subsequent invasive cancer development can only be studied over long periods and in large cohorts. Decisions on implementing primary HPV testing are often based on studies with CIN2 or CIN3 as the primary outcome due to the rarity of invasive cancer.
Methods
In collaboration with over 100 general practitioners and screening clinics in the Greater Manchester area, cervical cell samples were collected from 49,655 women attending for routine cytology screening 1988-1993. There was no age restriction. HPV testing (HPV L1 MY09/MY11 consensus primers) was carried out between 1990 and 1996 on a random sample of 7278 women, 6462 of whom gave a satisfactory β-globin result. The cohort has been linked to national cancer registration for CIN3 and cancer, with a median follow-up of 26 years.
Results
Follow-up identified 1143 cases of CIN3 and 138 invasive cervical cancers. Stored samples from cervical cancers, CIN3s and random controls are being tested for HPV. A preliminary analysis included 126 cases of CIN3 and 17 invasive cervical cancers among 6215 women whose entry sample was tested for HPV in 1990-1996. The cumulative invasive cervical cancer risk 25 years after testing positive for HPV16/18 (270 women) was 2.7% (95%CI: 1.3%-5.5%: 7 cancers) and for other HR-types (169 women) was 1.2% (95%CI: 0.3%-4.7%: 2 cancers). The cumulative risk following a negative HPV test (5,776 women) was 0.13% (95%CI:0.06%-0.28%: 7 cancers). The ratio of CIN3 to invasive cancer decreased with increasing time and CIN3 was rarely diagnosed above age 45. We did not observe any additional CIN3 diagnoses beyond 13 years in women who tested HPV positive at baseline.
Conclusions
CIN3 risk declined sharply beyond 5 years after HPV detection, however the invasive cancer risk remains elevated into middle and old age. More detailed results by age and HPV status will be presented.