Journal of Medical Screening > Volume 15, Number 2 > Pp. 97-104

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Original Articles

Safety of screening with Human papillomavirus testing for cervical cancer at three-year intervals in a high-risk population: experience from the LAMS study^*

S F Derchain, Associate Professor of Gynaecology , Universidade Estadual de Campinas, Campinas, Brazil

L O Sarian, Assistant Professor of Gynaecology  , Universidade Estadual de Campinas, Campinas, Brazil

P Naud, Associate Professor of Gynaecology , Hospital de Clínicas de Porto Alegre, Brazil

C Roteli-Martins, Assistant Gynaecologist , Hospital Leonor M de Barros, São Paulo, Brazil

A Longatto-Filho, Scientific Researcher , Instituto Adolfo Lutz, São Paulo, Brazil, and Life and Health Sciences Research Institute School of Health Sciences, University of Minho, Braga, Portugal

S Tatti, Professor of Gynaecology and Chief of the Colposcopic Clinic , First Chair Gynecology Hospital de Clínicas, Buenos Aires, Argentina

M Branca, Pathologist , Unit of Cytopathology, National Centre of Epidemiology, Surveillance and Promotion of Health, National Institute of Health (ISS), Rome, Italy

M Eren, Associate Professor of Pathology , SIZE Diagnostic Center, Ljubljana, Slovenia

L Serpa-Hammes, Gynaecologist , Hospital de Clinicas de Porto Alegre, Brazil

J Matos, Gynaecologist , Hospital de Clinicas de Porto Alegre, Brazil

R C Gontijo, Gynaecologist , Universidade Estadual de Campinas, Campinas, Brazil

J F Bragança, Gynaecologist , Universidade Estadual de Campinas, Campinas, Brazil

T P Lima, Gynaecologist , Hospital Leonor M de Barros, São Paulo, Brazill

M Y S Maeda, Scientific Researcher , Instituto Adolfo Lutz, São Paulo, Brazil

A Lörincz, Scientific Researcher , Digene Corp., Maryland, USA

G B Dores, Scientific Researcher , Digene Brazil, São Paulo, Brazil

S Costa, Associate Professor , Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, Bologna, Italy

S Syrjänen, Professor of Oral Pathology , Department of Oral Pathology, Institute of Dentistry, University of Turku, Finland

K Syrjänen, Professor , Department of Oncology & Radiotherapy, Turku University Hospital, Turku, Finland

Correspondence to: Luís Otávio Sarian, Alexander Fleming, 848, Nova Campinas, Campinas, São Paulo, Brazil; sarian{at}terra.com.br

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Objectives To assess whether human papillomavirus (HPV) testing is a safe enough approach to warrant extension of the screening intervals of baseline Papanicolaou (Pap)–/HPV– women in low-income settings.

Methods Of the >1000 women prospectively followed up as part of the Latin American Screening (LAMS) Study in São Paulo, Campinas, Porto Alegre) and Buenos Aires, 470 women with both baseline cytology and Hybrid Capture 2 (HC2) results available were included in this analysis. These baseline Pap-negative and HC2– or HC2+ women were controlled at six-month intervals with colposcopy, HC2 and Pap to assess the cumulative risk of incident Pap smear abnormalities and their predictive factors.

Results Of the 470 women, 324 (68.9%) were high-risk HPV (hrHPV) positive and 146 (31.1%) were negative. Having two or more lifetime sex partners (odds ratio [OR] = 2.63; 95% CI 1.70–3.51) and women using hormonal contraception (OR = 2.21; 95% CI 1.40–3.51) were at increased risk for baseline hrHPV infection. Baseline hrHPV+ women had a significantly increased risk of incident abnormal Pap smears during the follow-up. Survival curves deviate from each other starting at month 24 onwards, when hrHPV+ women start rapidly accumulating incident Pap smear abnormalities, including atypical squamous cells (ASC) or worse (log-rank; P < 0.001), low-grade squamous intraepithelial lesions (LSIL) or worse (P < 0.001) and high-grade squamous intraepithelial lesions (HSIL) (P = 0.03). Among the baseline hrHPV– women, the acquisition of incident hrHPV during the follow-up period significantly increased the risk of incident cytological abnormalities (hazard ratio = 3.5; 95% CI 1.1–11.7).

Conclusion These data implicate that HPV testing for hrHPV types might be a safe enough approach to warrant extension of the screening interval of hrHPV–/Pap–women even in low-resource settings. Although some women will inevitably contract hrHPV, the process to develop HSIL will be long enough to enable their detection at the next screening round (e.g. after three years).

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