Risk assessment in a Chinese cohort of 96 318 females undergoing opportunistic cervical cancer screening

To assess CIN3+ risk in a Chinese cohort of outpatients undergoing contesting screening and to evaluate the portability of the American Society for Colposcopy and Cervical Pathology (ASCCP) risk-based management, which was primarily developed using data from the Kaiser Permanente of Northern California (KPNC) cohort.

Females aged 25-65 years who were screened with cytology and high-risk human papillomavirus (hrHPV) co-testing between 2011 and 2020 at Wuhan Union Hospital (WHUH) were retrospectively studied. The risks of immediate and 3-year CIN3+ were estimated via prevalence-incidence mixture models. Portability was evaluated via the ratio of the observation risk in the WHUH cohort to the expected risk in the KPNC cohort (O/E) and its 95% CI.

A total of 96 318 females were included, and 16.83% of the women tested hrHPV-positive at initial screening, who had a CIN3+ immediate risk of 14.14%. The CIN3+ immediate risk varied between subgroups of positive HPV16 (34.09%), HPV18 (13.38%), other HPV types (6.71%), and negative hrHPV (0.12%). Compared to the KPNC cohort, our cohort exhibited a significantly higher CIN3+ immediate risk (1.42% vs 0.46%; O/E, 3.09; 95% CI, 2.92-3.26) and disproportionately increased cancer immediate risks in most subgroups requiring immediate colposcopy or treatment, as well as higher 3-year CIN3+ risks in women with hrHPV-negative ASC-US/NILM. Yet, the action threshold suggested by ASCCP, a CIN3+ immediate risk of 4%, showed good portability to our cohort.

Despite the higher risks in our cohort, the ASCCP clinical action threshold remains portable. For women with minimal abnormalities or normal results, shortened follow-up intervals should be considered.