{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T13:32:59Z","timestamp":1773667979123,"version":"3.50.1"},"reference-count":13,"publisher":"Wiley","issue":"23","license":[{"start":{"date-parts":[[2016,9,22]],"date-time":"2016-09-22T00:00:00Z","timestamp":1474502400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>The objective of cervical screening is to detect and treat precancer to prevent cervical cancer mortality and morbidity while minimizing overtreatment of benign human papillomavirus (HPV) infections and related minor abnormalities. HPV\/cytology cotesting at extended 5\u2010year intervals currently is a recommended screening strategy in the United States, but the interval extension is controversial. In the current study, the authors examined the impact of a decade of an alternative, 3\u2010year cotesting, on rates of precancer and cancer at Kaiser Permanente Northern California. The effect on screening efficiency, defined as numbers of cotests\/colposcopy visits needed to detect a precancer, also was considered.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Two cohorts were defined. The \u201copen cohort\u201d included all women screened at least once during the study period;\u2009&gt;\u20091 million cotests were performed. In a fixed \u201clong\u2010term screening cohort,\u201d the authors considered the cumulative impact of repeated screening at 3\u2010year intervals by restricting the cohort to women first cotested in 2003 through 2004 (ie, no women entering screening later were added to this group).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Detection of cervical intraepithelial neoplasia 3\/adenocarcinoma in situ (CIN3\/AIS) increased in the open cohort (2004\u20102006: 82.0\/100,000 women screened; 2007\u20102009: 140.6\/100,000 women screened; and 2010\u20102012: 126.0\/100,000 women screened); cancer diagnoses were unchanged. In the long\u2010term screening cohort, the detection of CIN3\/AIS increased and then decreased to the original level (2004\u20102006: 80.5\/100,000 women screened; 2007\u20102009: 118.6\/100,000 women screened; and 2010\u20102012: 84.9.\/100,000 women screened). The number of cancer diagnoses was found to decrease. When viewed in terms of screening efficiency, the number of colposcopies performed to detect a single case of CIN3\/AIS increased in the cohort with repeat screening.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Repeated cotesting at a 3\u2010year interval eventually lowers population rates of precancer and cancer. However, a greater number of colposcopies are required to detect a single precancer. <jats:bold><jats:italic>Cancer<\/jats:italic> 2016;122:3682\u20106.<\/jats:bold> \u00a9 <jats:italic>2016 American Cancer Society<\/jats:italic>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.30277","type":"journal-article","created":{"date-parts":[[2016,9,22]],"date-time":"2016-09-22T12:20:10Z","timestamp":1474546810000},"page":"3682-3686","source":"Crossref","is-referenced-by-count":14,"title":["The population impact of human papillomavirus\/cytology cervical cotesting at 3\u2010year intervals: Reduced cervical cancer risk and decreased yield of precancer per screen"],"prefix":"10.1002","volume":"122","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4080-7242","authenticated-orcid":false,"given":"Michelle I.","family":"Silver","sequence":"first","affiliation":[{"name":"Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services Bethesda Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Schiffman","sequence":"additional","affiliation":[{"name":"Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services Bethesda Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Fetterman","sequence":"additional","affiliation":[{"name":"Regional Laboratory, Kaiser Permanente Northern California Berkeley California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy E.","family":"Poitras","sequence":"additional","affiliation":[{"name":"Regional Laboratory, Kaiser Permanente Northern California Berkeley California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia C.","family":"Gage","sequence":"additional","affiliation":[{"name":"Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services Bethesda Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Wentzensen","sequence":"additional","affiliation":[{"name":"Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services Bethesda Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Lorey","sequence":"additional","affiliation":[{"name":"Regional Laboratory, Kaiser Permanente Northern California Berkeley California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walter K.","family":"Kinney","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip E.","family":"Castle","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program Oakland California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,9,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-156-12-201206190-00424"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPTGD94EVRSJCG"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1097\/AOG.0b013e318277c92a","article-title":"ACOG Practice Bulletin Number 131: screening for cervical cancer","volume":"120","author":"Committee on Practice Bulletins\u2010Gynecology","year":"2012","journal-title":"Obstet 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