Effect of Several Negative Rounds of Human Papillomavirus and Cytology Co-testing on Safety Against Cervical Cancer: An Observational Cohort Study.
Ann Intern Med
; 168(1): 20-29, 2018 01 02.
Article
em En
| MEDLINE
| ID: mdl-29181509
ABSTRACT
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. Primary Funding Source National Cancer Institute Intramural Research Program.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Papillomaviridae
/
Carcinoma in Situ
/
Adenocarcinoma
/
Displasia do Colo do Útero
/
Neoplasias do Colo do Útero
/
Programas de Rastreamento
/
Infecções por Papillomavirus
Tipo de estudo:
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Ann Intern Med
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
China