Variable risk of cervical precancer and XXXX after a @entity1082 -positive test.

@entity1 @entity975 @entity5 @entity1083 @entity1082 @entity3146
OBJECTIVE: To explore the effect of screening history on the risk of cervical precancer and @entity5 after an @entity1082 )-positive test. METHODS: A large health maintenance organization introduced cytology and HPV cotesting into routine clinical practice in 2003. We selected @entity1 aged 30 and older who tested HPV positive, cytology negative between January 2006 and December 2008 who had any clinical follow-up documented before January 2010 (n=26,799). The 1-year and 4-year cumulative incidence rates and rate ratios for @entity3146 or higher (CIN 2+) with 95% confidence intervals (95% CIs) were calculated as estimates of absolute risk and relative risk, respectively. Results were stratified on immediate past HPV test and @entity975 results. RESULTS: Without consideration of past screening round, the 1-year and 4-year cumulative incidence rates for CIN 2+ after an HPV-positive, @entity975 -negative result were 2.83 (95% CI 2.55-3.12) and 7.89 (95% CI 7.00-8.78). However, risks varied substantially by past screening result. For example, the 4-year risk of CIN2+ was greater for @entity1 who had a past HPV-positive, @entity975 -negative result (cumulative incidence rate=11.79, 95% CI 10.22-13.36) compared with those who had HPV-negative, @entity975 -negative result (cumulative incidence rate=4.56, 95% CI 3.43-5.69; cumulative incidence rate ratio=2.59, 95% CI 2.30-2.87). CONCLUSION: Because cervical precancer is associated with persistent @entity1083 , the risk associated with an HPV-positive test can vary significantly depending on the immediate past screening round. Optimizing screening programs will require knowledge of screening history.
