The Correlation Between Human Papillomavirus Positivity and Abnormal Cervical Cytology Result Differs by Age Among Perimenopausal Women

Objectives. We explored the age-stratified correlates and correlations between high-risk human papillomavirus (HR-HPV) infection and cervical abnormalities in perimenopausal women. Materials and Methods. Human papillomavirus testing and Pap smear screening were performed at baseline on 841 routinely screened women age 35 to 60 years in the HPV in perimenopause cohort. Demographic, behavioral, and medical information was collected through telephone-administered questionnaires. Descriptive analyses were used to examine the correlation between HR-HPV infection and cervical abnormalities by age. Logistic regression was used to determine correlates of HPV and abnormalities in women younger and older than 45 years. Results. The prevalence of HPV, HR-HPV, and cervical abnormalities decreased significantly with increasing age, as did the correlation between HR-HPV and cervical abnormalities. The prevalence of HR-HPV was 50% among younger women with abnormalities but this decreased steadily to 20% HR-HPV detection among 50- to 54-year-old women, and no abnormalities were detected in 55- to 60-year-old women. Different correlates of HR-HPV infection and abnormalities were observed in women 45 years or older, a pattern not seen in younger women. Conclusions. Although the relative proportion of low-grade and high-grade abnormalities did not change with age, we saw a loss of concordance between HR-HPV detection and cytological abnormalities with increasing age. Current guidelines for cervical cancer screening group together all women age 30 years and older. Our data raise important questions about the interpretation of HPV and Pap test results in this age group and suggest that ongoing surveillance of HPV and cytology in cervical cancer screening programs consider a third age stratification among older women.