{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:16:38Z","timestamp":1790885798964,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,11,7]],"date-time":"2019-11-07T00:00:00Z","timestamp":1573084800000},"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","id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To estimate long\u2010term cervical intraepithelial neoplasia grade 3 (CIN3) risks associated with different triage strategies for human papillomavirus\u00a0positive (HPV+) women with a view to reducing unnecessary referrals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>The ARTISTIC trial cohort was recruited in Manchester in 2001\u201303 and was followed up for CIN3 and cancer notification through national registration until December 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 10\u2010year cumulative risk of CIN3+ was much higher for women with HPV16\/18 infection (19.4%, 95% CI 15.8\u201323.8% with borderline\/low\u2010grade cytology and 10.7%, 95% CI 8.3\u201313.9% with normal cytology) than for those with other HPV types (7.3%, 95% CI 5.4\u20139.7% with borderline\/low\u2010grade cytology and 3.2%, 95% CI 2.2\u20134.5% with normal cytology). Among the 379 women with normal to low\u2010grade cytology and new HPV infection, the 10\u2010year cumulative CIN3+ risk was 2.9% (95% CI 1.6\u20135.2%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The CIN3 risk is confined to women with persistent type\u2010specific HPV so partial genotyping test assays identifying HPV16\/18 as a minimum are essential for efficient risk stratification. Immediate referral to colposcopy for HPV+ women with borderline or low\u2010grade cytology and referral after a year if still HPV+ with normal cytology may be unnecessary. Low\u2010grade lesions can safely be retested to identify those with persistent HPV. Recall intervals of 1\u00a0year for HPV16\/18 and 2\u00a0years for other high\u2010risk HPVs are justified for women with normal cytology and might also be considered for women with borderline\/low\u2010grade cytology. The minimal risk of invasive cancer that has progressed beyond stage 1A must be weighed against the advantages for patients and the NHS of reducing the number of referrals to colposcopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Cervical screening would be better for women and cheaper for the NHS if women with HPV and normal to low\u2010grade cytology were retested after a year or two when many infections will have cleared.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15957","type":"journal-article","created":{"date-parts":[[2019,9,21]],"date-time":"2019-09-21T08:23:50Z","timestamp":1569054230000},"page":"58-68","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Triaging women with\u00a0human papillomavirus infection and\u00a0normal cytology or low\u2010grade dyskaryosis: evidence from 10\u2010year follow up of the ARTISTIC trial cohort"],"prefix":"10.1111","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9477-6090","authenticated-orcid":false,"given":"C","family":"Gilham","sequence":"first","affiliation":[{"name":"London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Sargent","sequence":"additional","affiliation":[{"name":"Clinical Virology Manchester University NHS Foundation Trust Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Peto","sequence":"additional","affiliation":[{"name":"London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,11,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta13510"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2011.01.008"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta18230"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62218-7"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16674-9"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2016.290"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2014.65"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e5174"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)12490-X"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djq356"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2569"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2015.11.015"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l240"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta23280"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.07.049"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2014-202681"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6603955"},{"key":"e_1_2_6_19_1","unstructured":"MossS GibneyAHPV.Primary Screening Pilots: Evaluation report to the National Screening Committee 2015. 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