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Author Notes:

Julia W. Gargano, Centers for Disease Control and Prevention, MS C09, 1600 Clifton Rd. NE, Atlanta, GA 30333, Phone: 404-718-4893, jgargano@cdc.gov

We would like to thank Drs. Jin-Mann Lin, Roumiana Boneva and Mona Saraiya for their comments and suggestions on this manuscript.

Authors declare no conflicts of interest.


Research Funding:

This work was supported in part by the National Cancer Institute’s Early Detection Research Network (EDRN); Interagency Agreements Y1-CN-0101-01 and Y1-CN-5005-01.

Rosane Nisenbaum gratefully acknowledges the support of the Ontario Ministry of Health and Long-Term Care.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Public, Environmental & Occupational Health
  • RISK

Age-Group Differences in Human Papillomavirus Types and Cofactors for Cervical Intraepithelial Neoplasia 3 among Women Referred to Colposcopy

Journal Title:

Cancer Epidemiology, Biomarkers and Prevention


Volume 21, Number 1


, Pages 111-121

Type of Work:

Article | Post-print: After Peer Review


Background: Recommendations for high-risk human papillomavirus (HR-HPV) testing as an adjunct to cytology for cervical cancer screening differ by age group, because HR-HPV tests lack adequate specificity in women aged <30. Here, we assess age-group differences in HPV types and other risk factors for cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) versus CIN0-2 in women from four colposcopy clinics. Methods: Women ages 18 to 69 (n = 1,658) were enrolled and completed structured interviews to elicit data on behavioral risk factors prior to their examinations. HPV genotyping was done on exfoliated cervical cell samples. We estimated relative risks (RR) for HPV types and cofactors for CIN3+, overall and stratified by age group. Results: After 2 years of follow-up, we identified 178 CIN3+, 1,305 CIN0-2, and 175 indeterminate outcomes. Nonvaccine HR-HPV types were only associated with CIN3+ among women ≥30 (RR = 2.3, 95% CI: 1.5-3.4; <30: RR=0.9). Among all HR-HPV-positive women, adjusting for age, significant cofactors for CIN3+ included current smoking (RR = 1.5), former smoking (RR = 1.8), regular Pap screening (RR = 0.7), current regular condom use (RR = 0.5), and parity ≥5 (RR = 1.6, P trend for increasing parity = 0.07). However, the parity association differed by age group (≥30: RR = 1.8, P trend = 0.008; <30: RR = 0.9; P trend = .55). Conclusion: Subgroup variation by age in the risk of CIN3+ points to the importance of the timing of exposures in relation to CIN3+ detection. Impact: Future screening strategies need to consider natural history and secular trends in cofactor prevalence in the pursuit of appropriately sensitive and specific screening tools applied to appropriate age groups.

Copyright information:

©2011 AACR.

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