High rate of persistent HPV detection after diagnostic cervical excision in older screen‐positive women
Introduction Diagnostic work‐up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the transformation zone. To reduce the risk of missing disease, a diagnostic cervical excision may be performed. However, little is known on treatment...
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| Published in: | Acta obstetricia et gynecologica Scandinavica Vol. 104; no. 2; pp. 342 - 349 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
John Wiley & Sons, Inc
01.02.2025
John Wiley and Sons Inc Wiley |
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| ISSN: | 0001-6349, 1600-0412, 1600-0412 |
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| Abstract | Introduction
Diagnostic work‐up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the transformation zone. To reduce the risk of missing disease, a diagnostic cervical excision may be performed. However, little is known on treatment efficacy and post‐treatment surveillance for older women. We aimed to investigate the proportion of women testing negative for human papillomavirus (HPV) following a diagnostic cervical excision due to an abnormal screening test.
Material and Methods
We conducted a prospective cohort study on women aged ≥45 years who were referred for colposcopy due to an abnormal screening test between March 2019 and June 2021. All women had incomplete visualization of the transformation zone and underwent colposcopy and a diagnostic cervical excision at the first visit. Women were followed from date of excision until January 30, 2023. Follow‐up data was retrieved from the Danish Pathology Databank, and baseline characteristics were obtained from medical records. Cox regression was used on interval‐censored data to estimate crude and adjusted hazard ratios for a negative HPV test after cervical excision, stratified by histology and age.
Results
A total of 100 women underwent a diagnostic cervical excision and had at least one HPV test during follow‐up. Median age was 67.4 years, and median follow‐up time was 2.9 years. At the end of follow‐up, 70% tested HPV negative. Women with cervical intraepithelial neoplasia grade two or worse in their excision specimen were more likely to test HPV negative at the first test after cervical excision compared to women with less than cervical intraepithelial neoplasia grade two, however, not statistically significant (adjusted hazard ratio 1.69, 95% CI 0.92–3.10). Women aged 65–84 years were less likely to test HPV negative compared to women <65 years (adjusted hazard ratio 0.49, 95% CI 0.28–0.87).
Conclusions
In older women undergoing a diagnostic cervical excision, 70% tested HPV negative after 2.9 years, leaving 30% with persistent HPV positivity. More studies are needed to determine the risks associated with continued HPV positivity in the absence of high‐grade disease. Furthermore, given the absence of specific guidelines, the optimal surveillance frequency remains unknown.
Among older women monitored for 2.9 years after a diagnostic cervical excision, 70% tested negative for HPV. Consequently, 30% continued to test positive and remained in follow‐up. The optimal surveillance frequency and methods for these women remain uncertain. |
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| AbstractList | Diagnostic work-up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the transformation zone. To reduce the risk of missing disease, a diagnostic cervical excision may be performed. However, little is known on treatment efficacy and post-treatment surveillance for older women. We aimed to investigate the proportion of women testing negative for human papillomavirus (HPV) following a diagnostic cervical excision due to an abnormal screening test.
We conducted a prospective cohort study on women aged ≥45 years who were referred for colposcopy due to an abnormal screening test between March 2019 and June 2021. All women had incomplete visualization of the transformation zone and underwent colposcopy and a diagnostic cervical excision at the first visit. Women were followed from date of excision until January 30, 2023. Follow-up data was retrieved from the Danish Pathology Databank, and baseline characteristics were obtained from medical records. Cox regression was used on interval-censored data to estimate crude and adjusted hazard ratios for a negative HPV test after cervical excision, stratified by histology and age.
A total of 100 women underwent a diagnostic cervical excision and had at least one HPV test during follow-up. Median age was 67.4 years, and median follow-up time was 2.9 years. At the end of follow-up, 70% tested HPV negative. Women with cervical intraepithelial neoplasia grade two or worse in their excision specimen were more likely to test HPV negative at the first test after cervical excision compared to women with less than cervical intraepithelial neoplasia grade two, however, not statistically significant (adjusted hazard ratio 1.69, 95% CI 0.92-3.10). Women aged 65-84 years were less likely to test HPV negative compared to women <65 years (adjusted hazard ratio 0.49, 95% CI 0.28-0.87).
In older women undergoing a diagnostic cervical excision, 70% tested HPV negative after 2.9 years, leaving 30% with persistent HPV positivity. More studies are needed to determine the risks associated with continued HPV positivity in the absence of high-grade disease. Furthermore, given the absence of specific guidelines, the optimal surveillance frequency remains unknown. Introduction Diagnostic work‐up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the transformation zone. To reduce the risk of missing disease, a diagnostic cervical excision may be performed. However, little is known on treatment efficacy and post‐treatment surveillance for older women. We aimed to investigate the proportion of women testing negative for human papillomavirus (HPV) following a diagnostic cervical excision due to an abnormal screening test. Material and Methods We conducted a prospective cohort study on women aged ≥45 years who were referred for colposcopy due to an abnormal screening test between March 2019 and June 2021. All women had incomplete visualization of the transformation zone and underwent colposcopy and a diagnostic cervical excision at the first visit. Women were followed from date of excision until January 30, 2023. Follow‐up data was retrieved from the Danish Pathology Databank, and baseline characteristics were obtained from medical records. Cox regression was used on interval‐censored data to estimate crude and adjusted hazard ratios for a negative HPV test after cervical excision, stratified by histology and age. Results A total of 100 women underwent a diagnostic cervical excision and had at least one HPV test during follow‐up. Median age was 67.4 years, and median follow‐up time was 2.9 years. At the end of follow‐up, 70% tested HPV negative. Women with cervical intraepithelial neoplasia grade two or worse in their excision specimen were more likely to test HPV negative at the first test after cervical excision compared to women with less than cervical intraepithelial neoplasia grade two, however, not statistically significant (adjusted hazard ratio 1.69, 95% CI 0.92–3.10). Women aged 65–84 years were less likely to test HPV negative compared to women <65 years (adjusted hazard ratio 0.49, 95% CI 0.28–0.87). Conclusions In older women undergoing a diagnostic cervical excision, 70% tested HPV negative after 2.9 years, leaving 30% with persistent HPV positivity. More studies are needed to determine the risks associated with continued HPV positivity in the absence of high‐grade disease. Furthermore, given the absence of specific guidelines, the optimal surveillance frequency remains unknown. Among older women monitored for 2.9 years after a diagnostic cervical excision, 70% tested negative for HPV. Consequently, 30% continued to test positive and remained in follow‐up. The optimal surveillance frequency and methods for these women remain uncertain. Diagnostic work-up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the transformation zone. To reduce the risk of missing disease, a diagnostic cervical excision may be performed. However, little is known on treatment efficacy and post-treatment surveillance for older women. We aimed to investigate the proportion of women testing negative for human papillomavirus (HPV) following a diagnostic cervical excision due to an abnormal screening test.INTRODUCTIONDiagnostic work-up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the transformation zone. To reduce the risk of missing disease, a diagnostic cervical excision may be performed. However, little is known on treatment efficacy and post-treatment surveillance for older women. We aimed to investigate the proportion of women testing negative for human papillomavirus (HPV) following a diagnostic cervical excision due to an abnormal screening test.We conducted a prospective cohort study on women aged ≥45 years who were referred for colposcopy due to an abnormal screening test between March 2019 and June 2021. All women had incomplete visualization of the transformation zone and underwent colposcopy and a diagnostic cervical excision at the first visit. Women were followed from date of excision until January 30, 2023. Follow-up data was retrieved from the Danish Pathology Databank, and baseline characteristics were obtained from medical records. Cox regression was used on interval-censored data to estimate crude and adjusted hazard ratios for a negative HPV test after cervical excision, stratified by histology and age.MATERIAL AND METHODSWe conducted a prospective cohort study on women aged ≥45 years who were referred for colposcopy due to an abnormal screening test between March 2019 and June 2021. All women had incomplete visualization of the transformation zone and underwent colposcopy and a diagnostic cervical excision at the first visit. Women were followed from date of excision until January 30, 2023. Follow-up data was retrieved from the Danish Pathology Databank, and baseline characteristics were obtained from medical records. Cox regression was used on interval-censored data to estimate crude and adjusted hazard ratios for a negative HPV test after cervical excision, stratified by histology and age.A total of 100 women underwent a diagnostic cervical excision and had at least one HPV test during follow-up. Median age was 67.4 years, and median follow-up time was 2.9 years. At the end of follow-up, 70% tested HPV negative. Women with cervical intraepithelial neoplasia grade two or worse in their excision specimen were more likely to test HPV negative at the first test after cervical excision compared to women with less than cervical intraepithelial neoplasia grade two, however, not statistically significant (adjusted hazard ratio 1.69, 95% CI 0.92-3.10). Women aged 65-84 years were less likely to test HPV negative compared to women <65 years (adjusted hazard ratio 0.49, 95% CI 0.28-0.87).RESULTSA total of 100 women underwent a diagnostic cervical excision and had at least one HPV test during follow-up. Median age was 67.4 years, and median follow-up time was 2.9 years. At the end of follow-up, 70% tested HPV negative. Women with cervical intraepithelial neoplasia grade two or worse in their excision specimen were more likely to test HPV negative at the first test after cervical excision compared to women with less than cervical intraepithelial neoplasia grade two, however, not statistically significant (adjusted hazard ratio 1.69, 95% CI 0.92-3.10). Women aged 65-84 years were less likely to test HPV negative compared to women <65 years (adjusted hazard ratio 0.49, 95% CI 0.28-0.87).In older women undergoing a diagnostic cervical excision, 70% tested HPV negative after 2.9 years, leaving 30% with persistent HPV positivity. More studies are needed to determine the risks associated with continued HPV positivity in the absence of high-grade disease. Furthermore, given the absence of specific guidelines, the optimal surveillance frequency remains unknown.CONCLUSIONSIn older women undergoing a diagnostic cervical excision, 70% tested HPV negative after 2.9 years, leaving 30% with persistent HPV positivity. More studies are needed to determine the risks associated with continued HPV positivity in the absence of high-grade disease. Furthermore, given the absence of specific guidelines, the optimal surveillance frequency remains unknown. Among older women monitored for 2.9 years after a diagnostic cervical excision, 70% tested negative for HPV. Consequently, 30% continued to test positive and remained in follow‐up. The optimal surveillance frequency and methods for these women remain uncertain. Abstract Introduction Diagnostic work‐up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the transformation zone. To reduce the risk of missing disease, a diagnostic cervical excision may be performed. However, little is known on treatment efficacy and post‐treatment surveillance for older women. We aimed to investigate the proportion of women testing negative for human papillomavirus (HPV) following a diagnostic cervical excision due to an abnormal screening test. Material and Methods We conducted a prospective cohort study on women aged ≥45 years who were referred for colposcopy due to an abnormal screening test between March 2019 and June 2021. All women had incomplete visualization of the transformation zone and underwent colposcopy and a diagnostic cervical excision at the first visit. Women were followed from date of excision until January 30, 2023. Follow‐up data was retrieved from the Danish Pathology Databank, and baseline characteristics were obtained from medical records. Cox regression was used on interval‐censored data to estimate crude and adjusted hazard ratios for a negative HPV test after cervical excision, stratified by histology and age. Results A total of 100 women underwent a diagnostic cervical excision and had at least one HPV test during follow‐up. Median age was 67.4 years, and median follow‐up time was 2.9 years. At the end of follow‐up, 70% tested HPV negative. Women with cervical intraepithelial neoplasia grade two or worse in their excision specimen were more likely to test HPV negative at the first test after cervical excision compared to women with less than cervical intraepithelial neoplasia grade two, however, not statistically significant (adjusted hazard ratio 1.69, 95% CI 0.92–3.10). Women aged 65–84 years were less likely to test HPV negative compared to women <65 years (adjusted hazard ratio 0.49, 95% CI 0.28–0.87). Conclusions In older women undergoing a diagnostic cervical excision, 70% tested HPV negative after 2.9 years, leaving 30% with persistent HPV positivity. More studies are needed to determine the risks associated with continued HPV positivity in the absence of high‐grade disease. Furthermore, given the absence of specific guidelines, the optimal surveillance frequency remains unknown. IntroductionDiagnostic work‐up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the transformation zone. To reduce the risk of missing disease, a diagnostic cervical excision may be performed. However, little is known on treatment efficacy and post‐treatment surveillance for older women. We aimed to investigate the proportion of women testing negative for human papillomavirus (HPV) following a diagnostic cervical excision due to an abnormal screening test.Material and MethodsWe conducted a prospective cohort study on women aged ≥45 years who were referred for colposcopy due to an abnormal screening test between March 2019 and June 2021. All women had incomplete visualization of the transformation zone and underwent colposcopy and a diagnostic cervical excision at the first visit. Women were followed from date of excision until January 30, 2023. Follow‐up data was retrieved from the Danish Pathology Databank, and baseline characteristics were obtained from medical records. Cox regression was used on interval‐censored data to estimate crude and adjusted hazard ratios for a negative HPV test after cervical excision, stratified by histology and age.ResultsA total of 100 women underwent a diagnostic cervical excision and had at least one HPV test during follow‐up. Median age was 67.4 years, and median follow‐up time was 2.9 years. At the end of follow‐up, 70% tested HPV negative. Women with cervical intraepithelial neoplasia grade two or worse in their excision specimen were more likely to test HPV negative at the first test after cervical excision compared to women with less than cervical intraepithelial neoplasia grade two, however, not statistically significant (adjusted hazard ratio 1.69, 95% CI 0.92–3.10). Women aged 65–84 years were less likely to test HPV negative compared to women <65 years (adjusted hazard ratio 0.49, 95% CI 0.28–0.87).ConclusionsIn older women undergoing a diagnostic cervical excision, 70% tested HPV negative after 2.9 years, leaving 30% with persistent HPV positivity. More studies are needed to determine the risks associated with continued HPV positivity in the absence of high‐grade disease. Furthermore, given the absence of specific guidelines, the optimal surveillance frequency remains unknown. |
| Author | Sardini, Bayan Andersen, Berit Hammer, Anne Petersen, Lone Kjeld Tranberg, Mette Bor, Pinar Gustafson, Line Winther Krog, Louise |
| AuthorAffiliation | 3 Department of Clinical Medicine Aarhus University Aarhus Denmark 2 Department of Obstetrics and Gynecology Aarhus University Hospital Aarhus Denmark 8 University Clinic for HPV‐related Gynecological Disease Department of Obstetrics and Gynecology, Gødstrup Hospital Herning Denmark 5 Department of Obstetrics and Gynecology Odense University Hospital Odense Denmark 6 Department of Clinical Medicine University of Southern Denmark Odense Denmark 7 Department of Obstetrics and Gynecology Randers Regional Hospital Randers Denmark 1 University Research Clinic for Cancer Screening Department of Public Health Programmes, Randers Regional Hospital Randers Denmark 4 Department of Pathology Randers Regional Hospital Randers Denmark |
| AuthorAffiliation_xml | – name: 3 Department of Clinical Medicine Aarhus University Aarhus Denmark – name: 2 Department of Obstetrics and Gynecology Aarhus University Hospital Aarhus Denmark – name: 4 Department of Pathology Randers Regional Hospital Randers Denmark – name: 5 Department of Obstetrics and Gynecology Odense University Hospital Odense Denmark – name: 8 University Clinic for HPV‐related Gynecological Disease Department of Obstetrics and Gynecology, Gødstrup Hospital Herning Denmark – name: 6 Department of Clinical Medicine University of Southern Denmark Odense Denmark – name: 1 University Research Clinic for Cancer Screening Department of Public Health Programmes, Randers Regional Hospital Randers Denmark – name: 7 Department of Obstetrics and Gynecology Randers Regional Hospital Randers Denmark |
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| Keywords | large loop excision of the transformation zone loss of HPV detection test‐of‐cure postmenopausal women cervical intraepithelial neoplasia HPV |
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Diagnostic work‐up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the... Diagnostic work-up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the transformation... IntroductionDiagnostic work‐up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the... Among older women monitored for 2.9 years after a diagnostic cervical excision, 70% tested negative for HPV. Consequently, 30% continued to test positive and... Abstract Introduction Diagnostic work‐up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of... |
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| SubjectTerms | Aged Cervical cancer cervical intraepithelial neoplasia Cervix Uteri - pathology Cervix Uteri - surgery Cervix Uteri - virology Colposcopy Denmark - epidemiology Early Detection of Cancer Female Gynecology HPV Human papillomavirus Humans large loop excision of the transformation zone loss of HPV detection Medical screening Middle Aged Original Research Papillomaviridae - isolation & purification Papillomavirus Infections - diagnosis postmenopausal women Prospective Studies Surveillance test‐of‐cure Uterine Cervical Dysplasia - diagnosis Uterine Cervical Dysplasia - surgery Uterine Cervical Dysplasia - virology Uterine Cervical Neoplasms - diagnosis Uterine Cervical Neoplasms - pathology Uterine Cervical Neoplasms - surgery Uterine Cervical Neoplasms - virology Womens health |
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| Title | High rate of persistent HPV detection after diagnostic cervical excision in older screen‐positive women |
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