Age-group differences in human papillomavirus types and cofactors for cervical intraepithelial neoplasia 3 among women referred to colposcopy

Julia W. Gargano, Rosane Nisenbaum, Daisy R. Lee, Mack Ruffin, Martin Steinau, Ira R. Horowitz, Lisa C. Flowers, Talaat S. Tadros, George Birdsong, Elizabeth R. Unger

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Recommendations for high-risk human papillomavirus (HR-HPV) testing as an adjunct to cytology for cervical cancer screening differ by age group, because HR-HPV tests lack adequate specificity in women aged <30. Here, we assess age-group differences in HPV types and other risk factors for cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) versus CIN0-2 in women from four colposcopy clinics. Methods: Women ages 18 to 69 (n = 1,658) were enrolled and completed structured interviews to elicit data on behavioral risk factors prior to their examinations. HPV genotyping was done on exfoliated cervical cell samples. We estimated relative risks (RR) for HPV types and cofactors for CIN3+, overall and stratified by age group. Results: After 2 years of follow-up, we identified 178 CIN3+, 1,305 CIN0-2, and 175 indeterminate outcomes. Nonvaccine HR-HPV types were only associated with CIN3+ among women ≥30 (RR = 2.3, 95% CI: 1.5-3.4; <30: RR=0.9). Among all HR-HPV-positive women, adjusting for age, significant cofactors for CIN3+ included current smoking (RR = 1.5), former smoking (RR = 1.8), regular Pap screening (RR = 0.7), current regular condom use (RR = 0.5), and parity ≥5 (RR = 1.6, P trend for increasing parity = 0.07). However, the parity association differed by age group (≥30: RR = 1.8, P trend = 0.008; <30: RR = 0.9; P trend = .55). Conclusion: Subgroup variation by age in the risk of CIN3+ points to the importance of the timing of exposures in relation to CIN3+ detection. Impact: Future screening strategies need to consider natural history and secular trends in cofactor prevalence in the pursuit of appropriately sensitive and specific screening tools applied to appropriate age groups.

Original languageEnglish (US)
Pages (from-to)111-121
Number of pages11
JournalCancer Epidemiology Biomarkers and Prevention
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2012

Fingerprint

Colposcopy
Cervical Intraepithelial Neoplasia
Age Groups
Parity
Smoking
Condoms
Natural History
Early Detection of Cancer
Uterine Cervical Neoplasms

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Oncology

Cite this

Gargano, Julia W. ; Nisenbaum, Rosane ; Lee, Daisy R. ; Ruffin, Mack ; Steinau, Martin ; Horowitz, Ira R. ; Flowers, Lisa C. ; Tadros, Talaat S. ; Birdsong, George ; Unger, Elizabeth R. / Age-group differences in human papillomavirus types and cofactors for cervical intraepithelial neoplasia 3 among women referred to colposcopy. In: Cancer Epidemiology Biomarkers and Prevention. 2012 ; Vol. 21, No. 1. pp. 111-121.
@article{2da9332fea7f4b26b43276cc88825c09,
title = "Age-group differences in human papillomavirus types and cofactors for cervical intraepithelial neoplasia 3 among women referred to colposcopy",
abstract = "Background: Recommendations for high-risk human papillomavirus (HR-HPV) testing as an adjunct to cytology for cervical cancer screening differ by age group, because HR-HPV tests lack adequate specificity in women aged <30. Here, we assess age-group differences in HPV types and other risk factors for cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) versus CIN0-2 in women from four colposcopy clinics. Methods: Women ages 18 to 69 (n = 1,658) were enrolled and completed structured interviews to elicit data on behavioral risk factors prior to their examinations. HPV genotyping was done on exfoliated cervical cell samples. We estimated relative risks (RR) for HPV types and cofactors for CIN3+, overall and stratified by age group. Results: After 2 years of follow-up, we identified 178 CIN3+, 1,305 CIN0-2, and 175 indeterminate outcomes. Nonvaccine HR-HPV types were only associated with CIN3+ among women ≥30 (RR = 2.3, 95{\%} CI: 1.5-3.4; <30: RR=0.9). Among all HR-HPV-positive women, adjusting for age, significant cofactors for CIN3+ included current smoking (RR = 1.5), former smoking (RR = 1.8), regular Pap screening (RR = 0.7), current regular condom use (RR = 0.5), and parity ≥5 (RR = 1.6, P trend for increasing parity = 0.07). However, the parity association differed by age group (≥30: RR = 1.8, P trend = 0.008; <30: RR = 0.9; P trend = .55). Conclusion: Subgroup variation by age in the risk of CIN3+ points to the importance of the timing of exposures in relation to CIN3+ detection. Impact: Future screening strategies need to consider natural history and secular trends in cofactor prevalence in the pursuit of appropriately sensitive and specific screening tools applied to appropriate age groups.",
author = "Gargano, {Julia W.} and Rosane Nisenbaum and Lee, {Daisy R.} and Mack Ruffin and Martin Steinau and Horowitz, {Ira R.} and Flowers, {Lisa C.} and Tadros, {Talaat S.} and George Birdsong and Unger, {Elizabeth R.}",
year = "2012",
month = "1",
day = "1",
doi = "10.1158/1055-9965.EPI-11-0664",
language = "English (US)",
volume = "21",
pages = "111--121",
journal = "Cancer Epidemiology Biomarkers and Prevention",
issn = "1055-9965",
publisher = "American Association for Cancer Research Inc.",
number = "1",

}

Age-group differences in human papillomavirus types and cofactors for cervical intraepithelial neoplasia 3 among women referred to colposcopy. / Gargano, Julia W.; Nisenbaum, Rosane; Lee, Daisy R.; Ruffin, Mack; Steinau, Martin; Horowitz, Ira R.; Flowers, Lisa C.; Tadros, Talaat S.; Birdsong, George; Unger, Elizabeth R.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 21, No. 1, 01.01.2012, p. 111-121.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Age-group differences in human papillomavirus types and cofactors for cervical intraepithelial neoplasia 3 among women referred to colposcopy

AU - Gargano, Julia W.

AU - Nisenbaum, Rosane

AU - Lee, Daisy R.

AU - Ruffin, Mack

AU - Steinau, Martin

AU - Horowitz, Ira R.

AU - Flowers, Lisa C.

AU - Tadros, Talaat S.

AU - Birdsong, George

AU - Unger, Elizabeth R.

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Background: Recommendations for high-risk human papillomavirus (HR-HPV) testing as an adjunct to cytology for cervical cancer screening differ by age group, because HR-HPV tests lack adequate specificity in women aged <30. Here, we assess age-group differences in HPV types and other risk factors for cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) versus CIN0-2 in women from four colposcopy clinics. Methods: Women ages 18 to 69 (n = 1,658) were enrolled and completed structured interviews to elicit data on behavioral risk factors prior to their examinations. HPV genotyping was done on exfoliated cervical cell samples. We estimated relative risks (RR) for HPV types and cofactors for CIN3+, overall and stratified by age group. Results: After 2 years of follow-up, we identified 178 CIN3+, 1,305 CIN0-2, and 175 indeterminate outcomes. Nonvaccine HR-HPV types were only associated with CIN3+ among women ≥30 (RR = 2.3, 95% CI: 1.5-3.4; <30: RR=0.9). Among all HR-HPV-positive women, adjusting for age, significant cofactors for CIN3+ included current smoking (RR = 1.5), former smoking (RR = 1.8), regular Pap screening (RR = 0.7), current regular condom use (RR = 0.5), and parity ≥5 (RR = 1.6, P trend for increasing parity = 0.07). However, the parity association differed by age group (≥30: RR = 1.8, P trend = 0.008; <30: RR = 0.9; P trend = .55). Conclusion: Subgroup variation by age in the risk of CIN3+ points to the importance of the timing of exposures in relation to CIN3+ detection. Impact: Future screening strategies need to consider natural history and secular trends in cofactor prevalence in the pursuit of appropriately sensitive and specific screening tools applied to appropriate age groups.

AB - Background: Recommendations for high-risk human papillomavirus (HR-HPV) testing as an adjunct to cytology for cervical cancer screening differ by age group, because HR-HPV tests lack adequate specificity in women aged <30. Here, we assess age-group differences in HPV types and other risk factors for cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) versus CIN0-2 in women from four colposcopy clinics. Methods: Women ages 18 to 69 (n = 1,658) were enrolled and completed structured interviews to elicit data on behavioral risk factors prior to their examinations. HPV genotyping was done on exfoliated cervical cell samples. We estimated relative risks (RR) for HPV types and cofactors for CIN3+, overall and stratified by age group. Results: After 2 years of follow-up, we identified 178 CIN3+, 1,305 CIN0-2, and 175 indeterminate outcomes. Nonvaccine HR-HPV types were only associated with CIN3+ among women ≥30 (RR = 2.3, 95% CI: 1.5-3.4; <30: RR=0.9). Among all HR-HPV-positive women, adjusting for age, significant cofactors for CIN3+ included current smoking (RR = 1.5), former smoking (RR = 1.8), regular Pap screening (RR = 0.7), current regular condom use (RR = 0.5), and parity ≥5 (RR = 1.6, P trend for increasing parity = 0.07). However, the parity association differed by age group (≥30: RR = 1.8, P trend = 0.008; <30: RR = 0.9; P trend = .55). Conclusion: Subgroup variation by age in the risk of CIN3+ points to the importance of the timing of exposures in relation to CIN3+ detection. Impact: Future screening strategies need to consider natural history and secular trends in cofactor prevalence in the pursuit of appropriately sensitive and specific screening tools applied to appropriate age groups.

UR - http://www.scopus.com/inward/record.url?scp=84862917274&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862917274&partnerID=8YFLogxK

U2 - 10.1158/1055-9965.EPI-11-0664

DO - 10.1158/1055-9965.EPI-11-0664

M3 - Article

C2 - 22028398

AN - SCOPUS:84862917274

VL - 21

SP - 111

EP - 121

JO - Cancer Epidemiology Biomarkers and Prevention

JF - Cancer Epidemiology Biomarkers and Prevention

SN - 1055-9965

IS - 1

ER -