The Pittsburgh Cervical Cancer Screening Model Indicates That Patient History Significantly Impacts Future Cervical Cancer Risk in Patients with Current Negative HPV Results
Erika F Rodriguez, Agnieska Onisko, R Marshall Austin. University of Pittsburgh, Pittsburgh, PA; School of Information Sciences, University of Pittsburgh, Pittsburgh, PA; Magee-Womens Hospital of University of Pittsburgh, Pittsburgh, PA
Background: Recent cervical screening guidelines emphasize current high risk (hr) HPV and/or cytology cervical screening as the basis for risk stratification and follow-up. We utilized, the Pittsburgh Cervical Cancer Screening Model (PCCSM) to assess the impact of patient history on subsequent risk for invasive cervical cancer (CxCa) in patients with current negative (neg) hrHPV results.
Design: Utilizing the dynamic Bayesian PCCSM, we estimated 5-year risk projections for CxCa in patients with current cervical screening test (CST) results of either hrHPV-Neg ASCUS or hrHPV-Neg Pap-Neg (“double-negative”) results (DNR). Risk assessment calculations took into account both current (CST) as well as previous patient's results. Our database included 696,172 liquid based cytologies, 155,246 adjunctive hrHPV tests, and follow-up surgicals from approximately 10% of 271,029 patients. Vaginal cytologies and patients with only one cervical cytology and no follow-up were excluded.
Results: Cervical cytologies (525,689) from 156,534 patients (ave age µ=41.1) were included. Patients with current hrHPV-Neg ASCUS and history of recent histopathologic CxCa were associated with the highest subsequent risk for development of either CxCa, followed by recent prior histopathologic CIN3/AIS. Prior history of either malignant/suspicious cytology or HSIL were associated with the next highest estimated risk for subsequent CxCa among patients with current hrHPV-Neg ASCUS. Similar trends were noted for patients with current DNR, but at lower risk levels. Figure 1 shows cumulative relative risk of CxCa in patients with (A) current hrHPV-Neg ASCUS (B) current DNR.
Conclusions: PCCSM shows that higher future risk estimates were associated with current hrHPV-Neg ASCUS than with current DNR. This may be due to risks associated with undetected latent persistent hrHPV infections. The PCCSM indicates that patient history should be taken considered when developing individualized CST recommendations.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 58, Monday Morning