ArticleEClinicalMedicine2020
A study of type-specific HPV natural history and implications for contemporary cervical cancer screening programs.
Article in EClinicalMedicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 118 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
118 citing papers in PubMed, 3 syntheses or guidelines pooled it, 210 citations in OpenAlex.
- Maximizing impact: the power of early HPV vaccination for long-term protection-lessons from a systematic review and meta-regression analysis.Journal of public health (Oxford, England) · 2026Pooled it
- Self-Collected Vaginal Specimens for HPV Testing: Recommendations From the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee.Journal of lower genital tract disease · 2025Guideline
- Applying Results of Extended Genotyping to Management of Positive Cervicovaginal Human Papillomavirus Test Results: Enduring Guidelines.Journal of lower genital tract disease · 2025Guideline
- Variations in the Natural History of High-Risk HPV Types Following HPV-16/18 Bivalent Vaccination in Females Aged 18-45 Years.Nature communications · 2026Trial
- Extended HPV genotyping by the BD Onclarity assay: concordance with screening HPV-DNA assays, triage biomarkers, and histopathology in women from the NTCC2 study.Microbiology spectrum · 2025Trial
- Human papillomavirus-encoded microRNAs: key regulators in cervical cancer development.RNA biology · 2026Review
- Resource-Adapted Triage Strategies for Women Testing HPV Positive With Self-Collected Vaginal Samples in Cameroon.International journal of cancer · 2026Article
- HPV positivity despite cytological negativity: Risk assessment with colposcopic and histopathological findings.Pakistan journal of medical sciences · 2026Article
- Longitudinal analysis of high-risk HPV infections reveals within-host viral genome changes over time.PLoS pathogens · 2026Article
- Longitudinal Change in CD86 Expression Is Associated with Regression of Cervical Intraepithelial Neoplasia.Biomedicines · 2026Article
- Beyond HPV in Eastern Europe: Genotype Distribution, Molecular Biomarkers, Vaginal Microbiome, and Implications for Cervical Cancer Prevention.Life (Basel, Switzerland) · 2026Review
- Health care policy trial of primary human papillomavirus-based cervical screening in Denmark: Comparison of three triage algorithms.International journal of cancer · 2026Article
- Prevalence and genotype distribution of human papillomavirus (HPV) in Tehran, Iran: a retrospective cross sectional study (2011-2024).Virology journal · 2026Article
- HPV16 genetic variation provides evidence of positive natural selection driven by HLA class I.Nature communications · 2026Article
- Urban-rural disparities in HPV prevalence and genotype distribution: a large-scale cervical cancer screening study in Xi'an, China.BMC infectious diseases · 2026Article
- Urine-based detection of HPV for cervical cancer screening: towards clinical implementation.Journal of clinical microbiology · 2026Article
- Long-Term Prospective Cohort Study of Cervical Cancer Screening Using Triage of Women Who Are Human Papillomavirus-Positive With Dual Stain and Human Papillomavirus Genotyping.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2026Observational
- HPV testing with 16/18 genotyping for risk stratification among women with normal cytology: a multicenter prospective cohort study from China.Journal of clinical microbiology · 2026Article
- Epidemiological approaches to evaluate clinical unmasking of HPV-associated cervical lesions in the HPV vaccination era.International journal of cancer · 2026Review
- Long-term human papillomavirus genotype-specific risk of cervical high-grade intraepithelial lesion and cancer-By age group and triage cytology.International journal of cancer · 2026Article
58 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
23 authors at 10 institutions in 3 countries.
Funding
Abstract
backgroundHPV testing is replacing cytology for cervical cancer screening because of greater sensitivity and superior reassurance following negative tests for the dozen HPV genotypes that cause cervical cancer. Management of women testing positive is unresolved. The need for identification of individual HPV genotypes for clinical use is debated. Also, it is unclear how long to observe persistent infections when precancer is not initially found.
methodsIn the longitudinal NCI-Kaiser Permanente Northern California Persistence and Progression (PaP) Study, we observed the clinical outcomes (clearance, progression to CIN3+, or persistence without progression) of 11,573 HPV-positive women aged 30-65 yielding 14,158 type-specific infections.
findingsRisks of CIN3+ progression differed substantially by type, with HPV16 conveying uniquely elevated risk (26% of infections with seven-year CIN3+ risk of 22%). The other carcinogenic HPV types fell into 3 distinct seven-year CIN3+ risk groups: HPV18, 45 (13% of infections, risks >5%, with known elevated cancer risk); HPV31, 33, 35, 52, 58 (39%, risks >5%); and HPV39, 51, 56, 59, 68 (23%, risks <5%). In the absence of progression, HPV clearance rates were similar by type, with 80% of infections no longer detected within three years; persistence to seven years without progression was uncommon. The predictive value of abnormal cytology was most evident for prevalent CIN3+, but less evident in follow-up. A woman's age did not modify risk; rather it was the duration of persistence that was important.
interpretationHPV type and persistence are the major predictors of progression to CIN3+; at a minimum, distinguishing HPV16 is clinically important. Dividing the other HPV types into three risk-groups is worth considering.
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