Without mandatory high-risk HPV co-testing, are we inadequately screening for adenocarcinoma of the cervix?

Abstract

Objectives: High-risk human papillomavirus (hrHPV) is an important co-factor in the development of squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the cervix. Screening with the Papanicolaou test is more effective for SCC compared to AC, creating a missed opportunity for early detection if hrHPV co-testing is not performed. We sought to evaluate the effect of HPV status, as well as other risk factors, on the development of adenocarcinoma in situ (ACIS) and AC. Methods: We conducted a single-institution, retrospective case-control study. Cases consisted of women diagnosed with ACIS or AC of the cervix between 2007-2017. Controls consisted of patients without the diagnosis of ACIS or AC, randomly selected from a pool of potential control patients via a random number generator, with a cases to control ratio of 1:3. Univariable tests were applied on the basis of whether the variable of interest was distributed normally (ie, t test, analysis of variance) test with a 0.05 two-sided significance level. Results: A total of 118 cases (47 AC and 71 ACIS) and 289 controls were identified for inclusion in this study. The average age was 42.5 years (cases 39.7, controls 34.3, p=0.0001). 29% of AC patients were post-menopausal at time of diagnosis (14/47), 17% ACIS (12/71) and 33% controls (97/289) (p=0.0215). 34% of AC patients (16/47) and 24% of ACIS patients (17/71) had a significant smoking history compared to 18% of controls (53/289), (p=0.0309). 29% AC and 49% ACIS (35/71) patients had a co-existing preinvasive squamous a lesion at time of diagnosis compared to 26% of controls (76/289), (p=0.0024). Nulliparity was not significantly associated with AC/ACIS vs. controls (p=0.0696). 86% of AC patients (31/36) and 91% ACIS (63/69) were hrHPV positive at the time of diagnosis compared to 28% of controls (83/279) (p Conclusions: Patients with AC and ACIS were significantly more likely to be pre-menopausal, a current or former smoker, and have a co-existing HSIL/LSIL lesion. High-risk HPV status was positive in 90% of AC/ACIS patients whereas Pap cytology was normal in 26% of ACIS/AC patients preceding diagnosis. Pap cytology with mandatory hrHPV co-testing may be more effective screening for early detection of AC/ACIS. Download : Download high-res image (203KB) Download : Download full-size image