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Thomas S. Lorey, MD,3 Barbara Fetterman, STC(ASCP)†,4 Nancy E. Poitras, PMP,4 Brian ... Philip E. Castle, PhD, MPH,6 and Mark Schiffman, MD, MPH1.
ORIGINAL RESEARCH ARTICLES: CERVIX AND HPV

Low Risk of Cervical Cancer/Precancer Among Most Women Under Surveillance Postcolposcopy Maria Demarco, PhD,1 Li C. Cheung, PhD,1 Walter K. Kinney, MD,2 Nicolas Wentzensen, MD, PhD,1 Thomas S. Lorey, MD,3 Barbara Fetterman, STC(ASCP)†,4 Nancy E. Poitras, PMP,4 Brian Befano, BS,5 Philip E. Castle, PhD, MPH,6 and Mark Schiffman, MD, MPH1 Objective: To inform impending postcolposcopy guidelines, this analysis examined the subsequent risk of CIN 3+ among women with a grade lower than CIN 2 (< CIN 2) colposcopy results, taking into account the referring results that brought them to colposcopy and cotest results postcolposcopy. Methods: We analyzed 107,005 women from 25 to 65 years old, recommended for colposcopy at Kaiser Permanente Northern California. We estimated absolute risks of CIN 3+ among women: (1) recommended for colposcopy (precolposcopy), (2) following colposcopy and with histology results < CIN 2 (postcolposcopy), and (3) with cotest results 12 months after a < CIN 2 colposcopy (return cotest). Results: After colposcopy showing < CIN 2 (n = 69,790; 87% of the women at colposcopy), the 1-year risk of CIN 3+ was 1.2%, compared with 6.3% at the time of colposcopy recommendation. Negative cotest results 1 year after colposcopy identified a large group (37.1%) of women whose risk of CIN 3+ (i.e., LSILh HPV-/ASC-US or LSIL HPV-/NILM HPV+ overall HPV+/>LSIL HPV+/ASCUS or LSIL HPV+/NILM HPV- overall HPV-/>LSILh HPV-/ASC-US or LSIL HPV-/NILM h HPV+ overall HPV+/>LSIL HPV+/ASCUS or LSIL HPV+/NILM HPV- overall HPV-/>LSIL HPV-/ASC-US or LSIL h HPV-/NILM HPV+ overall HPV+/>LSIL HPV+/ASCUS or LSIL HPV+/NILM HPV- overall HPV-/>LSIL HPV-/ASC-US or LSIL HPV-/NILM HPV+ overall HPV+/>LSIL HPV+/ASCUS or LSIL HPV+/NILM HPV- overall HPV-/>LSIL h HPV-/ASC-US or LSIL HPV-/NILM i

397 145 174 78 630 22 88 514 353 69 118 160 2,662 58 147 2,420 781 163 370 244 1,840 39 227 1,565 7,280 467 4,625 2,118 1,1472 60 1,622 9,678 8,636 542 4,603 3,413 12,111 60 990 10,966 4,237 221 1,519 2,470 5,470 15 196 5,220

Percent 0.6 0.2 0.2 0.1 0.9 0.0 0.1 0.7 0.5 0.1 0.2 0.2 3.8 0.1 0.2 3.5 1.1 0.2 0.5 0.3 2.6 0.1 0.3 2.2 10.4 0.7 6.6 3.0 16.4 0.1 2.3 13.9 12.4 0.8 6.6 4.9 17.4 0.1 1.4 15.7 6.1 0.3 2.2 3.5 7.8 0.0 0.3 7.5

d

e

3 years after return cotest

n

Risk

nf

Risk

53 38 11 4 1 1 0 0 25 15 6 4 7 6 0 1 63 39 17 6 5 2 2 1 176 86 77 12 8 2 4 2 229 91 113 25 2 0 1 1 107 49 38 19 1 1 0 0

17.7 (13.9, 22.5) 24.1 (17.1, 31.1) 11.4 (7.0, 18.5) 7.7 (3.2, 18.0) 0.3 (0.1, 1.6) 4.5 (−4.1, 13.2) 0.0 0.0 8.8 (6.2, 12.6) 23.5 (14.8, 36.1) 4.2 (0.6, 7.9) 5.0 (2.4, 10.2) 0.2 (0.0, 0.4) 8.6 (1.4, 15.8) 0.0 10.7 (6.7, 16.8) 28.6 (21.7, 37.3) 6.7 (4.3, 10.3) 4.8 (2.6, 9.0) 0.5 (0.2, 1.1) 5.1 (−1.7, 12.0) 1.4 (0.4, 4.4) 0.2 (0, 1.0) 3.6 (2.8, 4.7) 20.8 (16.9, 25.3) 2.9 (2.4, 3.5) 1.3 (0.9, 2.0) 0.1 (0.1, 0.2) 4.1 (1.2, 13.8) 0.2 (−0.0, 0.4) 0.1 (0.0, 0.2) 4.4 (3.5, 5.4) 21.5 (17.8, 25.9) 4.0 (3.4, 4.7) 2.2 (1.6, 2.8) 0.1 (0.0, 0.2) 0.0 0.3 (0.1, 1.2) 0.1 (0.0, 0.2) 4.0 (3.4, 4.7) 27.5 (21.5, 34.6) 3.6 (2.7, 4.8) 2.2 (1.7, 3.0) 0.1 (0.0, 0.2) 6.7 (−5.9, 19.2) 0.0 0.1 (0, 0.2)

62 40 17 5 2 1 0 0 31 16 6 9 10 6 0 4 79 42 24 12 8 2 3 3 240 90 118 30 12 3 6 3 339 102 163 74 10 0 3 7 168 54 56 57 4 1 0 3

19.5 (15.4, 24.5) 12.8 (8.0, 20.1) 11.3 (5.4, 22.8) 0.6 (0.2, 2.0) 4.5 (−4.1, 13.2) 0.0 0.0 10.5 (7.6, 14.6) 26.1 (16.4, 40.1) 4.2 (0.6, 7.9) 7.3 (3.9, 13.2) 8.6 (1.4, 15.8) 0.0 12.6 (8.3, 19.0) 30.2 (22.9, 39.3) 8.7 (5.7, 12.9) 6.9 (4.0, 11.7) 0.7 (0.4, 1.4) 5.1 (−1.7, 12.0) 2.0 (0.8, 5.4) 4.7 (3.8, 5.8) 21.7 (17.8, 26.4) 4.0 (3.4, 4.8) 2.4 (1.7, 3.3) 0.3 (0.2, 0.4) 5.5 (1.7, 16.7) 0.2 (0.1, 0.3) 5.6 (4.7, 6.6) 23.4 (19.5, 28.0) 5.0 (4.3, 5.7) 3.5 (2.9, 4.3) 0.3 (0.2, 0.4) 0.0 0.7 (0.3, 1.7) 0.2 (0.1, 0.4) 5.3 (4.6, 6.1) 28.3 (22.3, 35.6) 4.9 (3.8, 6.2) 3.5 (2.8, 4.4) 0.2 (0.1, 0.5) 6.7 (−5.9, 19.2) 0.0 -

a

Postcolposcopy: women who went to colposcopy and had histology results of less than CIN 2 at baseline. Cotest results for HPV+ or HPV- overall include cytology categories shown and missing cytology (not shown in table). c No. CIN 3+ by the end of follow-up. d Percent of surveillance population (69,790 women with lower than CIN 2 histology at first colposcopy). e No. CIN 3+ at return cotest. f No. CIN 3+ 3-years after return cotest. g Includes AIS and cancer. h Estimate based on prevalent risk at return cotest. Inadequate data preclude risk estimate at 3 years. i Nonzero risk estimate with "0" cases because of Weibull assumptions. b

© 2018, ASCCP

101

Journal of Lower Genital Tract Disease • Volume 22, Number 2, April 2018

Demarco et al.

TABLE 5. Cancer Frequencies and Time to Diagnosis Postcolposcopy (