Developing and validating the Personal Risk of Oncogenic Human Papillomavirus infection score in US Women.

Abstract

Determining risk scores for genital high-risk human papillomavirus (HRHPV) infection in women will support more efficient cervical cancer screening strategies. We developed and validated point scores to predict the likelihood of any genital HRHPV infection in women. We conducted the cross-sectional analysis in 2017 and used data from the 2005-14 US National Health and Nutrition Examination Survey (7337 women aged 25-59 years; 6300 women aged 30-59 years). Predictors were reproductive health practices, risk behaviors and demographic variables. The outcome was a positive result for any of the 21 genital HRHPV genotypes. The 2005-12 cohorts were used as training and testing sets to develop scores that best classified women into three risk groups: low risk (<20%), average risk (20-30%) and high risk (>30%). The 2013-14 cohort was used to validate the final scores. Two-point scores with six self-reported variables were created to predict any HRHPV risks for the two age groups: the Personal Risk of Oncogenic HPV (PRO-HPV25) for women aged 25-59 years old and PRO-HPV30 for women aged 30-59 years old. The scores were successfully prospectively validated, with good calibration with regards to the predicted and observed rates of HRHPV infection. The scores had fair discrimination (c-statistics: 0.67-0.68). The PRO-HPV risk scores can identify groups at low, average and high risk of genital HRHPV infection. This information can be used to prioritize women for cervical cancer screening in low-resource settings or to personalize screening intervals.