Persistence of type-specific human papillomavirus infection and increased long-term risk of cervical cancer

Hui Chi Chen, Mark Schiffman, Ching Yu Lin, Mei Hung Pan, San Lin You, Li Chung Chuang, Chang Yao Hsieh, Kai Li Liaw, Ann W. Hsing, Chien Jen Chen

Research output: Contribution to journalArticle

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Abstract

Background:Human papillomavirus (HPV) persistence is the pivotal event in cervical carcinogenesis. We followed a large-scale community-based cohort for 16 years to investigate the role of genotype-specific HPV persistence in predicting cervical cancer including invasive and in situ carcinoma. Methods:At the baseline examination in 1991-1992, 11 923 participants (aged 30-65 years) consented to HPV testing and cytology; 6923 participants were reexamined in 1993-1995. For HPV testing, we used a polymerase chain reaction-based assay that detected 39 HPV types. Women who developed cervical cancer were identified from cancer and death registries. Cumulative risks for developing cervical cancer among infected and persistently infected women were calculated by the Kaplan-Meier method. Results:Of 10 123 women who were initially cytologically normal, 68 developed cervical cancer. The 16-year cumulative risks of subsequent cervical cancer for women with HPV16, HPV58 (without HPV16), or other carcinogenic HPV types (without HPV16 or HPV58) were 13.5%, 10.3%, and 4.0%, respectively, compared with 0.26% for HPV-negative women. Women with type-specific persistence of any carcinogenic HPV had greatly increased risk compared with women who were HPV-negative at both visits (hazard ratio = 75.4, 95% confidence interval = 31.8 to 178.9). The cumulative cervical cancer risks following persistent carcinogenic HPV infections increased with age: The risks were 5.5%, 14.4%, and 18.1% for women aged 30-44 years, 45-54 years, and 55 years and older, respectively. However, newly acquired infections were associated with a low risk of cervical cancer regardless of age. Conclusions:HPV negativity was associated with a very low long-term risk of cervical cancer. Persistent detection of HPV among cytologically normal women greatly increased risk. Thus, it is useful to perform repeated HPV testing following an initial positive test.

Original languageEnglish
Pages (from-to)1387-1396
Number of pages10
JournalJournal of the National Cancer Institute
Volume103
Issue number18
DOIs
Publication statusPublished - Sep 21 2011

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Papillomavirus Infections
Uterine Cervical Neoplasms
Carcinoma in Situ
Cell Biology
Registries
Carcinogenesis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Persistence of type-specific human papillomavirus infection and increased long-term risk of cervical cancer. / Chen, Hui Chi; Schiffman, Mark; Lin, Ching Yu; Pan, Mei Hung; You, San Lin; Chuang, Li Chung; Hsieh, Chang Yao; Liaw, Kai Li; Hsing, Ann W.; Chen, Chien Jen.

In: Journal of the National Cancer Institute, Vol. 103, No. 18, 21.09.2011, p. 1387-1396.

Research output: Contribution to journalArticle

Chen, HC, Schiffman, M, Lin, CY, Pan, MH, You, SL, Chuang, LC, Hsieh, CY, Liaw, KL, Hsing, AW & Chen, CJ 2011, 'Persistence of type-specific human papillomavirus infection and increased long-term risk of cervical cancer', Journal of the National Cancer Institute, vol. 103, no. 18, pp. 1387-1396. https://doi.org/10.1093/jnci/djr283
Chen, Hui Chi ; Schiffman, Mark ; Lin, Ching Yu ; Pan, Mei Hung ; You, San Lin ; Chuang, Li Chung ; Hsieh, Chang Yao ; Liaw, Kai Li ; Hsing, Ann W. ; Chen, Chien Jen. / Persistence of type-specific human papillomavirus infection and increased long-term risk of cervical cancer. In: Journal of the National Cancer Institute. 2011 ; Vol. 103, No. 18. pp. 1387-1396.
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abstract = "Background:Human papillomavirus (HPV) persistence is the pivotal event in cervical carcinogenesis. We followed a large-scale community-based cohort for 16 years to investigate the role of genotype-specific HPV persistence in predicting cervical cancer including invasive and in situ carcinoma. Methods:At the baseline examination in 1991-1992, 11 923 participants (aged 30-65 years) consented to HPV testing and cytology; 6923 participants were reexamined in 1993-1995. For HPV testing, we used a polymerase chain reaction-based assay that detected 39 HPV types. Women who developed cervical cancer were identified from cancer and death registries. Cumulative risks for developing cervical cancer among infected and persistently infected women were calculated by the Kaplan-Meier method. Results:Of 10 123 women who were initially cytologically normal, 68 developed cervical cancer. The 16-year cumulative risks of subsequent cervical cancer for women with HPV16, HPV58 (without HPV16), or other carcinogenic HPV types (without HPV16 or HPV58) were 13.5{\%}, 10.3{\%}, and 4.0{\%}, respectively, compared with 0.26{\%} for HPV-negative women. Women with type-specific persistence of any carcinogenic HPV had greatly increased risk compared with women who were HPV-negative at both visits (hazard ratio = 75.4, 95{\%} confidence interval = 31.8 to 178.9). The cumulative cervical cancer risks following persistent carcinogenic HPV infections increased with age: The risks were 5.5{\%}, 14.4{\%}, and 18.1{\%} for women aged 30-44 years, 45-54 years, and 55 years and older, respectively. However, newly acquired infections were associated with a low risk of cervical cancer regardless of age. Conclusions:HPV negativity was associated with a very low long-term risk of cervical cancer. Persistent detection of HPV among cytologically normal women greatly increased risk. Thus, it is useful to perform repeated HPV testing following an initial positive test.",
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AU - Schiffman, Mark

AU - Lin, Ching Yu

AU - Pan, Mei Hung

AU - You, San Lin

AU - Chuang, Li Chung

AU - Hsieh, Chang Yao

AU - Liaw, Kai Li

AU - Hsing, Ann W.

AU - Chen, Chien Jen

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N2 - Background:Human papillomavirus (HPV) persistence is the pivotal event in cervical carcinogenesis. We followed a large-scale community-based cohort for 16 years to investigate the role of genotype-specific HPV persistence in predicting cervical cancer including invasive and in situ carcinoma. Methods:At the baseline examination in 1991-1992, 11 923 participants (aged 30-65 years) consented to HPV testing and cytology; 6923 participants were reexamined in 1993-1995. For HPV testing, we used a polymerase chain reaction-based assay that detected 39 HPV types. Women who developed cervical cancer were identified from cancer and death registries. Cumulative risks for developing cervical cancer among infected and persistently infected women were calculated by the Kaplan-Meier method. Results:Of 10 123 women who were initially cytologically normal, 68 developed cervical cancer. The 16-year cumulative risks of subsequent cervical cancer for women with HPV16, HPV58 (without HPV16), or other carcinogenic HPV types (without HPV16 or HPV58) were 13.5%, 10.3%, and 4.0%, respectively, compared with 0.26% for HPV-negative women. Women with type-specific persistence of any carcinogenic HPV had greatly increased risk compared with women who were HPV-negative at both visits (hazard ratio = 75.4, 95% confidence interval = 31.8 to 178.9). The cumulative cervical cancer risks following persistent carcinogenic HPV infections increased with age: The risks were 5.5%, 14.4%, and 18.1% for women aged 30-44 years, 45-54 years, and 55 years and older, respectively. However, newly acquired infections were associated with a low risk of cervical cancer regardless of age. Conclusions:HPV negativity was associated with a very low long-term risk of cervical cancer. Persistent detection of HPV among cytologically normal women greatly increased risk. Thus, it is useful to perform repeated HPV testing following an initial positive test.

AB - Background:Human papillomavirus (HPV) persistence is the pivotal event in cervical carcinogenesis. We followed a large-scale community-based cohort for 16 years to investigate the role of genotype-specific HPV persistence in predicting cervical cancer including invasive and in situ carcinoma. Methods:At the baseline examination in 1991-1992, 11 923 participants (aged 30-65 years) consented to HPV testing and cytology; 6923 participants were reexamined in 1993-1995. For HPV testing, we used a polymerase chain reaction-based assay that detected 39 HPV types. Women who developed cervical cancer were identified from cancer and death registries. Cumulative risks for developing cervical cancer among infected and persistently infected women were calculated by the Kaplan-Meier method. Results:Of 10 123 women who were initially cytologically normal, 68 developed cervical cancer. The 16-year cumulative risks of subsequent cervical cancer for women with HPV16, HPV58 (without HPV16), or other carcinogenic HPV types (without HPV16 or HPV58) were 13.5%, 10.3%, and 4.0%, respectively, compared with 0.26% for HPV-negative women. Women with type-specific persistence of any carcinogenic HPV had greatly increased risk compared with women who were HPV-negative at both visits (hazard ratio = 75.4, 95% confidence interval = 31.8 to 178.9). The cumulative cervical cancer risks following persistent carcinogenic HPV infections increased with age: The risks were 5.5%, 14.4%, and 18.1% for women aged 30-44 years, 45-54 years, and 55 years and older, respectively. However, newly acquired infections were associated with a low risk of cervical cancer regardless of age. Conclusions:HPV negativity was associated with a very low long-term risk of cervical cancer. Persistent detection of HPV among cytologically normal women greatly increased risk. Thus, it is useful to perform repeated HPV testing following an initial positive test.

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