Table 3.
Medical histories of 16 women who were diagnosed with invasive cervical cancer during follow-up while participating in the natural history study of human papillomavirus (HPV) and cervical neoplasia in Guanacaste, Costa Rica (1993–2003). The cases history until the first histologic diagnosis of cancer is presented. Patients A, H, I and P reported respectively only 2, 4, 2, and 2 lifetime numbers of sexual partners in their follow-up questionnaires. Cancer patients E, F, and M were found through linkage with the cancer registry.
Colpo = colposcopic evaluation; Post-colpo = post-colposcopic evaluation; Pap = Papanicolaou smear; LBC = liquid-based cytology; CR = Costa Rica; JHU = Johns Hopkins Pathologist (M.E.S.); US = U.S. pathologist (M.H.L.); LEEP = loop electrosurgical excision procedure; Hyst = hysterectomy; CIN = cervical intraepithelial neoplasia; ASCUS = atypical cells of undetermined significance; LSIL = low-grade squamous intraepithelial lesion; HSIL = high-grade squamous intraepithelial lesion; Unsat = unsatisfactory; #Partners = lifetime number of sexual partners at enrollment; HCT = hybrid capture tube test result; AFS = age at first sexual intercourse; #Partners = lifetime number of sexual partners at enrollment
| Patient A (Age = 36; AFS = 15; #Partners = 4) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Normal | Normal | Normal | Normal (Normal)† | Negative | 16 | |||
| 0.0 | Screen | ASCUS | Cancer | P3-Cancer (Cancer)* | 16;45 | |||||
| 60.8 | Colpo | Cancer | Biopsy = Cancer |
| Patient B (Age = 50; AFS = 15; #Partners = 3) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Normal | Normal | Normal | Normal (Normal)† | Negative | Negative | |||
| 72.2 | Screen | ASCUS | CIN3# | Reactive | Normal (Normal)* | 18 | ||||
| 84.1 | Screen | CIN3 | CIN3 | Normal | Missing | |||||
| 85.8 | Colpo | HSIL | LEEP = Cancer |
| Patient C (Age = 29; AFS = 17; #Partners = 1) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Reactive | Normal | Inadequate | Normal | Negative | 18 | |||
| 60.3 | Screen | Reactive | ASCUS | P2-HSIL* | 18 | |||||
| 63.5 | Colpo | HSIL | LEEP = Cancer |
| Patient D (Age = 63; AFS = 18; #Partners = 6) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Normal | Normal | Normal | Normal‡ | Negative | 51;61 | |||
| 13.1 | Screen | Normal | Normal | Normal‡ | 33 | |||||
| 31.4 | Screen | Reactive | Normal | Normal‡ | 61 | |||||
| 44.3 | Screen | Normal | Normal | Normal‡ | Negative | |||||
| 56.7 | Screen | Normal | Normal | Normal‡ | Negative | |||||
| 60.4 | Screen | Normal | Normal | Normal‡ | Negative | |||||
| 84.2 | Screen | Cancer | CIN3 | ASCUS | Normal‡ | 33;35;52;58 | ||||
| 91.4 | Colpo | Cancer | Biopsy = Cancer |
| Patient E (Age = 75; AFS = 12; #Partners = 1) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Normal | Normal | Normal | Normal | Negative | Negative | |||
| 132.3 | Colpo | Biopsy = Cancer |
| Patient F (Age = 48; AFS = 23; #Partners = 1) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Reactive | Normal | Normal | Normal | Negative | Negative | |||
| 72.3 | Screen | Reactive | Normal | Reactive | Normal | Negative | ||||
| 73.6 | Colpo | Biopsy = Cancer |
| Patient G (Age = 23; AFS = 14; #Partners = 2) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Normal | ASCUS | ASCUS | P1-LSIL(HSIL)‡ | Positive | 16 | |||
| 1.4 | Colpo | LSIL | Biopsy = CIN1 | |||||||
| 18.4 | Screen | CIN2 | CIN2 | Missing | P1-LSIL(HSIL)‡ | 16 | ||||
| 21.8 | Colpo | HSIL | Biopsy = CIN1 | |||||||
| 23.9 | Post-colpo | HSIL | LEEP = Cancer |
| Patient H (Age = 64; AFS = 15; #Partners = 5) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Reactive | Normal | ASCUS | Normal (Normal)‡ | Positive | 45;51;58;84 | |||
| 5.2 | Colpo | 45; 58 | Normal | |||||||
| 19.6 | Screen | ASCUS | Cancer | Cancer | P0-Probably Normal* | 45 | ||||
| 21.2 | Colpo | Cancer | Biopsy = Cancer |
| Patient I (Age = 49; AFS = 15; #Partners = 3) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | ASCUS | Reactive | ASCUS | Normal (Normal)‡ | Positive | 16 | |||
| 2.9 | Colpo | 16 | Normal | |||||||
| 13.2 | Screen | Reactive | ASCUS | Reactive | Normal (Normal)* | 16 | ||||
| 26.4 | Screen | Normal | CIN3 | Normal (Normal)* | 16 | |||||
| 34.4 | ColpoΩ | Biopsy = Cancer |
| Patient J (Age = 61; AFS = 18; #Partners = 2) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Normal | ASCUS | ASCUS | Normal (Normal)‡ | Negative | Negative | |||
| 4.1 | Colpo | Negative | Normal | |||||||
| 13.6 | Screen | CIN3 | CIN3 | Cancer | P0-Probably Normal (HSIL)‡ | Negative | ||||
| 15.7 | Colpo | HSIL | Biopsy = Cancer |
| Patient K (Age = 37; AFS = 14; #Partners = 2) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Reactive | ASCUS | ASCUS | Normal (HSIL)‡ | Positive | 18 | |||
| 3.8 | Colpo | 18;61 | Normal | |||||||
| 10.4 | Screen | Reactive | Reactive | Normal (Metaplasia) | ||||||
| 13.4 | Screen | Inadequate | Inadequate | ASCUS | Normal | 18;85 | ||||
| 17.5 | Colpo | Unsat | Biopsy = Cancer |
| Patient L (Age = 28; AFS = 14; #Partners = 1) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Reactive | Normal | Missing | Normal (Normal) | Positive | 18;51 | |||
| 1.9 | Colpo | Normal | ||||||||
| 13.8 | Screen | Reactive | Normal | Reactive | Normal (Metaplasia) | 18 | ||||
| 26.5 | Screen | Reactive | Reactive | Normal (Metaplasia) | 18;55 | |||||
| 38.5 | Screen | Reactive | Normal | Normal (Normal)& | 18 | |||||
| 50.5 | Screen | Inadequate | Inadequate | Normal (Normal) | 18 | |||||
| 60.7 | Screen | Reactive | Normal | Normal (LSIL) | 18;56 | |||||
| 86.6 | Screen | Reactive | Normal | Reactive | Normal (HSIL) | 18;73 | ||||
| 96.5 | ColpoΔ | Unsat | ||||||||
| 98.1 | Post-colpo | CIN1 | Normal | |||||||
| 104.3 | Post-colpo | CIN3 | Normal | |||||||
| 105.9 | Post-colpo | Reactive | Normal | LEEP = Cancer |
| Patient M (Age = 63; AFS = 18;#Partners = 1) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Normal | ASCUS | Reactive | Normal | Positive | 16 | |||
| 1.8 | Colpo | 16 | Normal | |||||||
| 13.3 | Screen | Normal | ASCUS | CIN2 | Normal | 16;45 | ||||
| 16.5 | Colpo | Normal | ||||||||
| 26.2 | Post-colpo | Normal | ||||||||
| 106.0 | Screen | HSIL (CIN3) | HSIL (CIN2) | Normal | 16 | |||||
| 106.2 | Colpo | Normal | ||||||||
| 107.1 | Colpo | Hyst = Cancer |
| Patient N (Age = 39; AFS = 15; #Partners = 9) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Normal | Normal | CIN1 | Normal (Metaplasia)‡ | Negative | 16; 58 | |||
| 26.6 | Screen | CIN1 | CIN3 | Cancer | Normal (Normal)‡ | 16 | ||||
| 29.2 | Colpo | HSIL | Biopsy = CIN3 | |||||||
| 34.1 | Post-colpo | HSIL | LEEP = CIN2 | |||||||
| 43.1 | Post-colpo | Normal | ||||||||
| 55.1 | Post-colpo | Reactive | Normal | |||||||
| 112.2 | Screen | HSIL (CIN3) | HSIL (CIN2) | Normal | 16 | |||||
| 115.8 | Colpo | LSIL | LEEP = Cancer |
| Patient O (Age = 38; AFS = 15; #Partners = 5) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | CIN2 | Missing | CIN3 | Normal (Cancer) | Negative | 16;71 | |||
| 1.8 | Colpo | 16 | LSIL | Biopsy = CIN3 | ||||||
| 5.1 | Post-colpo | LEEP = CIN3 | ||||||||
| 76.0 | ColpoΩ | CIN3 | Cancer | Biopsy = Cancer |
| Patient P (Age = 46; AFS = 16; #Partners = 4) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Time (Months) | Visit Type | Pap (CR) | Pap (JHU) | LBC (US) | LBC (CR) | Cervigram (Review) | HCT | HPV (PCR) | Colpo | Histology |
| 0.0 | Screen | Normal | ASCUS | Normal | Normal& | Negative | 52 | |||
| 3.5 | Colpo | 52 | Normal | |||||||
| 13.2 | Screen | CIN3 | CIN2 | CIN3 | Normal (Normal)‡ | 52 | ||||
| 15.2 | Colpo | Nom | ||||||||
| 16.4 | Post-colpo | HSIL | LEEP = CIN3 | |||||||
| 81.0 | Colpo | Cancer | ||||||||
| 82.4 | Colpo | Cancer | Cancer | Biopsy = Cancer | ||||||
|
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