Risk Assessment in a Chinese Cohort of 96,318 Females Undergoing Opportunistic Cervical Cancer Screening.

Objective: To assess CIN3+ risk in a Chinese cohort of outpatients undergoing contesting screening and to evaluate the portability of the ASCCP risk-based management, which were primarily developed using data from the KPNC cohort.

Methods: Females aged 25-65 years who were screened with cytology and high-risk human papillomavirus (hrHPV) cotesting 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% confidence interval (CI).

Results: 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.

Conclusion: 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.