Effect of Several Negative Rounds of Human Papillomavirus and Cytology Co-testing on Safety Against Cervical Cancer An Observational Cohort Study

被引：53

作者：

Castle, Philip E. ^{[1
]}

Kinney, Walter K. ^{[2
]}

Xue, Xiaonan ^{[3
]}

Cheung, Li C. ^{[4
]}

Gage, Julia C. ^{[5
]}

Zhao, Fang-Hui ^{[6
]}

Fetterman, Barbara ^{[7
]}

Poitras, Nancy E. ^{[8
]}

Lorey, Thomas S. ^{[9
]}

Wentzensen, Nicolas ^{[10
]}

Katki, Hormuzd A. ^{[11
]}

Schiffman, Mark ^{[12
]}

机构：

[1] 1300 Morris Pk Ave,Belfer Bldg,Room 1308C, Bronx, NY 10461 USA

[2] 2589 Garden Highway, Sacramento, CA 95833 USA

[3] 1300 Morris Pk Ave,Room 1303C, Bronx, NY 10461 USA

[4] Room 7E612,9609 Med Ctr Dr, Rockville, MD 20850 USA

[5] Room 6E546,9609 Med Ctr Dr, Rockville, MD 20850 USA

[6] Chinese Acad Med Sci, Canc Inst Hosp, 17 South Panjiayuan Lane,POB 2258, Beijing 100021, Peoples R China

[7] TPMG Reg Lab, Cytol Dept, 1725 Eastshore Highway, Berkeley, CA 94710 USA

[8] Kaiser Permanente, 501 Lennon Lane, Walnut Creek, CA 94597 USA

[9] Kaiser Permanente Reg Labs, 1725 Eastshore Highway, Berkeley, CA 94710 USA

[10] Room 6E448,9609 Med Ctr Dr, Rockville, MD 20850 USA

[11] Room 7E606,9609 Med Ctr Dr, Rockville, MD 20850 USA

[12] Room 6E544,9609 Med Ctr Dr, Rockville, MD 20850 USA

来源：

ANNALS OF INTERNAL MEDICINE | 2018年 / 168卷 / 01期

基金：

美国国家卫生研究院;

关键词：

INTRAEPITHELIAL NEOPLASIA; INCIDENCE TRENDS; CONSENSUS GUIDELINES; AMERICAN SOCIETY; NATURAL-HISTORY; UNITED-STATES; FOLLOW-UP; WOMEN; RISK; ADENOCARCINOMA;

D O I：

10.7326/M17-1609

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Current U. S. cervical cancer screening and management guidelines do not consider previous screening history, because data on multiple-round human papillomavirus (HPV) and cytology "co-testing" have been unavailable. Objective: To measure cervical cancer risk in routine practice after successive negative screening co-tests at 3-year intervals. Design: Observational cohort study. Setting: Integrated health care system (Kaiser Permanente Northern California, Oakland, California). Patients: 990 013 women who had 1 or more co-tests from 2003 to 2014. Measurements: 3-and 5-year cumulative detection of (risk for) cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ, and cervical cancer (>= CIN3) in women with different numbers of negative co-tests, overall and within subgroups defined by previous co-test results or baseline age. Results: Five-year >= CIN3 risks decreased after each successive negative co-test screening round (0.098%, 0.052%, and 0.035%). Five-year >= CIN3 risks for an HPV-negative co-test, regardless of the cytology result, nearly matched the performance (reassurance) of a negative co-test for each successive round of screening (0.114%, 0.061%, and 0.041%). By comparison, >= CIN3 risks for the cytology-negative co-test, regardless of the HPV result, also decreased with each successive round, but 3-year risks were as high as 5-year risks after an HPV-negative co-test (0.199%, 0.065%, and 0.043%). No interval cervical cancer cases were diagnosed after the second negative co-test. Independently, >= CIN3 risks decreased with age. Length of previous screening interval did not influence future >= CIN3 risks. Limitation: Interval-censored observational data. Conclusion: After 1 or more negative cervical co-tests (or HPV tests), longer screening intervals (every 5 years or more) might be feasible and safe.

引用

页码：20 / +

页数：13

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