{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T04:39:45Z","timestamp":1771907985914,"version":"3.50.1"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T00:00:00Z","timestamp":1554681600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["A16892"],"award-info":[{"award-number":["A16892"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["A20303"],"award-info":[{"award-number":["A20303"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:p>US guidelines recommend that most women older than 65\u2009years cease cervical screening after two consecutive negative cotests (concurrent HPV and cytology tests) in the previous 10 years, with one in the last 5 years. However, this recommendation was based on expert opinion and modeling rather than empirical data on cancer risk. We therefore estimated the 5\u2010year risks of cervical precancer (cervical intraepithelial neoplasia grade 3 or adenocarcinoma<jats:italic>in situ<\/jats:italic>[CIN3]) after one, two and three negative cotests among 346,760 women aged 55\u201364\u2009years undergoing routine cotesting at Kaiser Permanente Northern California (2003\u20132015). Women with a history of excisional treatment or CIN2+ were excluded. No woman with one or more negative cotests was diagnosed with cancer during follow\u2010up. Five\u2010year risks of CIN3 after one, two, and three consecutive negative cotests were 0.034% (95% CI: 0.023%\u20130.046%), 0.041% (95% CI: 0.007%\u20130.076%) and 0.016% (95% CI: 0.000%\u20130.052%), respectively (<jats:italic>p<\/jats:italic><jats:sub>trend<\/jats:sub>&lt; 0.001). These risks did not appreciably differ by a positive cotest result prior to the one, two or three negative cotest(s). Since CIN3 risks after one or more negative cotests were significantly below a proposed 0.12% CIN3+ risk threshold for a 5\u2010year screening interval, a longer screening interval in these women is justified. However, the choice of how many negative cotests provide sufficient safety against invasive cancer over a woman's remaining life represents a value judgment based on the harms<jats:italic>versus<\/jats:italic>benefits of continued screening. Ideally, this guideline should be informed by longer\u2010term follow\u2010up given that exiting is a long\u2010term decision.<\/jats:p>","DOI":"10.1002\/ijc.32268","type":"journal-article","created":{"date-parts":[[2019,3,12]],"date-time":"2019-03-12T16:07:36Z","timestamp":1552406856000},"page":"617-626","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Absolute risks of cervical precancer among women who fulfill exiting guidelines based on HPV and cytology cotesting"],"prefix":"10.1002","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4042-4820","authenticated-orcid":false,"given":"Rebecca","family":"Landy","sequence":"first","affiliation":[{"name":"Centre for Cancer Prevention Wolfson Institute of Preventive Medicine, Queen Mary University of London London United Kingdom"},{"name":"Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, DHHS Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Schiffman","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, DHHS Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter D.","family":"Sasieni","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences &amp; Medicine School of Cancer &amp; Pharmaceutical Sciences, Guys Cancer Centre, Guys Hospital, King's College London London SE1 9RT United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li C.","family":"Cheung","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, DHHS Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hormuzd A.","family":"Katki","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, DHHS Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greg","family":"Rydzak","sequence":"additional","affiliation":[{"name":"Information Management Services Inc. Calverton MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Wentzensen","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, DHHS Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy E.","family":"Poitras","sequence":"additional","affiliation":[{"name":"Regional Laboratory Kaiser Permanente Northern California Berkeley CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Lorey","sequence":"additional","affiliation":[{"name":"Regional Laboratory Kaiser Permanente Northern California Berkeley CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walter K.","family":"Kinney","sequence":"additional","affiliation":[{"name":"Division of Gynaecologic Oncology Kaiser Permanente Medical Care Program Oakland CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1082-6554","authenticated-orcid":false,"given":"Philip E.","family":"Castle","sequence":"additional","affiliation":[{"name":"Albert Einstein College of Medicine Bronx NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,4,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e318285423c"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e318285437b"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e3182854253"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e3182854282"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e31828543c5"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/dju153"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6600974"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2968"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g130"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i276"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2015.03.008"},{"key":"e_1_2_6_13_1","volume-title":"Ministry of Health WaS. 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