Benchmarking CIN 3+ Risk as the Basis for Incorporating HPV and Pap Cotesting into Cervical Screening and Management Guidelines

Content Provider	Scilit
Author	Katki, Hormuzd A. Schiffman, Mark Castle, Philip E. Fetterman, Barbara Poitras, Nancy E. Lorey, Thomas Cheung, Li Raine-Bennett, Tina R. Gage, Julia C. Kinney, Walter K.
Copyright Year	2013
Description	Journal: Journal of Lower Genital Tract Disease Objective In 2012, the US Preventive Services Task Force (USPSTF) and a consensus of 25 organizations endorsed concurrent cytology and human papillomavirus (HPV) testing (“cotesting”) for cervical cancer screening. Past screening and management guidelines were implicitly based on risks defined by Pap-alone, without consideration of HPV test results. To promote management that is consistent with accepted practice, new guidelines incorporating cotesting should aim to achieve equal management of women at equal risk of cervical intraepithelial neoplasia grade 3 and cancer (CIN 3+). Methods We estimated cumulative 5-year risks of CIN 3+ for 965,360 women aged 30 to 64 years undergoing cotesting at Kaiser Permanente Northern California over 2003 to 2010. We calculated the implicit risk thresholds for Pap-alone and applied them for new management guidance on HPV and Pap cotesting, citing 2 examples: HPV-positive/atypical squamous cells of undetermined significance (ASC-US) and HPV-negative/Pap-negative. We call this guidance process “benchmarking.” Results A low-grade squamous intraepithelial lesion result, for which immediate colposcopy is prescribed, carries a 5-year CIN 3+ risk of 5.2%, suggesting that test results with similar risks should be managed with colposcopy. Similarly, ASC-US (2.6% risk) is managed with a 6- to 12-month follow-up visit and Pap-negative (0.26% risk) is managed with a 3-year follow-up visit. The 5-year CIN 3+ risk among women with HPV-positive/ASC-US was 6.8% (95% confidence interval = 6.2%–7.6%). This is greater than the 5.2% risk implicitly leading to referral for colposcopy, consistent with current management recommendations that women with HPV-positive/ASC-US be referred for immediate colposcopy. The 5-year CIN 3+ risk among women with HPV-negative/Pap-negative results was 0.08% (95% confidence interval = 0.07%–0.09%), far below the 0.26% implicitly required for a 3-year return and justifying a longer (e.g., 5-year) return. Conclusions Using the principle of “equal management of equal risks,” benchmarking to implicit risk thresholds based on Pap-alone can be used to achieve safe and consistent incorporation of cotesting.
Related Links	http://europepmc.org/articles/pmc3616419?pdf=render https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616419/pdf
Ending Page	S35
Page Count	8
Starting Page	S28
e-ISSN	15260976
DOI	10.1097/lgt.0b013e318285423c
Journal	Journal of Lower Genital Tract Disease
Issue Number	Supplement
Volume Number	17
Language	English
Publisher	Ovid Technologies (Wolters Kluwer Health)
Publisher Date	2013-04-01
Access Restriction	Open
Subject Keyword	Journal: Journal of Lower Genital Tract Disease Womens Studies Human Papillomavirus (hpv), Cancer Prevention, Pap, Cervical Intraepithelial Neoplasia (cin)
Content Type	Text
Resource Type	Article