Risk Prediction of Cervical Cancer and Precancers by Type-specific Human Papillomavirus: Evidence from a Population-based Cohort Study in China

Risk stratification of human papillomavirus (HPV)-positive women is needed to avoid excessive colposcopy and overtreatment in cervical cancer screening. We aimed to evaluate the predictive value of type-specific HPV in detecting cervical cancer and precancers in a Chinese population-based cohort and provide evidence of HPV genotyping to triage HPV-positive women. We typed all Hybrid Capture 2-positive cytological samples of 1,742 women in Shanxi Province Cervical Cancer Screening Study cohort. Cumulative risks of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) among HPV positive women and cumulative detection rates of CIN2+ among general women by type-specific HPV were estimated during the course of ten-year follow-up. HPV 16 and HPV 52 were most prevalent types among the screening population. Ten-year cumulative risk of CIN2+ was 47.5% (95%CI= 31.6% to 62.3%) for HPV 16 positive women and 46.3% (95%CI= 15.3% to 75.4%) for HPV 31 positive women. Ten-year cumulative risks of CIN2+ among HPV 58, 39, 33, 18 and 52 positive women ranged from 34.3% to 12.0% in a decreasing order. CIN2+ risks were found to be positively associated with infection times of the same genotypes of HPV 16, 31, 33 and 58 (all ptrend<0.001). Cumulative detection rates of CIN2+ within ten years were predominantly contributed by HPV 16, 31 and 58. Our results support the risk-based management of HPV positive women using HPV genotyping, and also indicate the significance of including HPV 31 and 58 apart from commonly acknowledged HPV 16 and HPV 18 in achieving better risk stratification.

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