Neither one-time negative screening tests nor negative colposcopy provides absolute reassurance against cervical cancer
Corresponding Author
Philip E. Castle
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
Fax: +301-402-0916.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd. Room 5030, EPS MSC 7234, Bethesda, MD 20892-7234, USASearch for more papers by this authorAna C. Rodríguez
Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
Search for more papers by this authorRobert D. Burk
Departments of Pediatrics, Microbiology and Immunology, Obstetrics & Gynecology and Women's Health, and Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY
Search for more papers by this authorRolando Herrero
Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
Search for more papers by this authorAllan Hildesheim
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
Search for more papers by this authorDiane Solomon
Division of Cancer Prevention, National Cancer Institute, NIH, Bethesda, MD
Search for more papers by this authorMark E. Sherman
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
Search for more papers by this authorJose Jeronimo
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
Program for Appropriate Technology in Health, Seattle, WA
Search for more papers by this authorMario Alfaro
Laboratorio Nacional de Citología, Caja Costarricense de Seguro Social, San Jose, Costa Rica
Search for more papers by this authorJorge Morales
Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
Search for more papers by this authorDiego Guillén
Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
Search for more papers by this authorMartha L. Hutchinson
Department of Pathology and Laboratory Medicine, Women and Infants' Hospital of Rhode Island, Providence, RI
Search for more papers by this authorSholom Wacholder
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
Search for more papers by this authorMark Schiffman
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
Search for more papers by this authorCorresponding Author
Philip E. Castle
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
Fax: +301-402-0916.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd. Room 5030, EPS MSC 7234, Bethesda, MD 20892-7234, USASearch for more papers by this authorAna C. Rodríguez
Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
Search for more papers by this authorRobert D. Burk
Departments of Pediatrics, Microbiology and Immunology, Obstetrics & Gynecology and Women's Health, and Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY
Search for more papers by this authorRolando Herrero
Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
Search for more papers by this authorAllan Hildesheim
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
Search for more papers by this authorDiane Solomon
Division of Cancer Prevention, National Cancer Institute, NIH, Bethesda, MD
Search for more papers by this authorMark E. Sherman
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
Search for more papers by this authorJose Jeronimo
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
Program for Appropriate Technology in Health, Seattle, WA
Search for more papers by this authorMario Alfaro
Laboratorio Nacional de Citología, Caja Costarricense de Seguro Social, San Jose, Costa Rica
Search for more papers by this authorJorge Morales
Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
Search for more papers by this authorDiego Guillén
Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
Search for more papers by this authorMartha L. Hutchinson
Department of Pathology and Laboratory Medicine, Women and Infants' Hospital of Rhode Island, Providence, RI
Search for more papers by this authorSholom Wacholder
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
Search for more papers by this authorMark Schiffman
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
Search for more papers by this authorAbstract
A population sample of 10,049 women living in Guanacaste, Costa Rica, was recruited into a natural history of human papillomavirus (HPV) and cervical neoplasia study in 1993–1994. At the enrollment visit, we applied multiple state-of-the-art cervical cancer screening methods to detect prevalent cervical cancer and to prevent subsequent cervical cancers by the timely detection and treatment of precancerous lesions. Women were screened at enrollment with 3 kinds of cytology (often reviewed by more than one pathologist), visual inspection and cervicography. Any positive screening test led to colposcopic referral and biopsy and/or excisional treatment of CIN2 or worse. We retrospectively tested stored specimens with an early HPV test (hybrid capture tube test) and for >40 HPV genotypes using a research PCR assay. We followed women typically 5–7 years and some up to 11 years. Nonetheless, 16 cases of invasive cervical cancer were diagnosed during follow-up. Six cancer cases were failures at enrollment to detect abnormalities by cytology screening; 3 of the 6 were also negative at enrollment by sensitive HPV DNA testing. Seven cancers represent failures of colposcopy to diagnose cancer or a precancerous lesion in screen-positive women. Finally, 3 cases arose despite attempted excisional treatment of precancerous lesions. Based on this evidence, we suggest that no current secondary cervical cancer prevention technologies applied once in a previously under-screened population is likely to be 100% efficacious in preventing incident diagnoses of invasive cervical cancer. © 2009 UICC
Supporting Information
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