Factors associated with timely colposcopy following an abnormal cervical cancer test result.
Factors associated with timely colposcopy following an abnormal cervical cancer test result.
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DOI：
10.1016/j.ypmed.2022.107307
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发表时间：
2022-11
影响因子：
5.1
通讯作者：
Kamineni, Aruna
中科院分区：
文献类型：
--
作者：
Feldman, Sarah;Lykken, Jacquelyn M.;Haas, Jennifer S.;Werner, Claudia L.;Kobrin, Sarah C.;Tiro, Jasmin A.;Chubak, Jessica;Kamineni, Aruna
关键词：
成功的宫颈癌预防需要筛查和对异常检测结果的适当管理。管理包括诊断评估和治疗，如果有指征，根据大多数异常检测结果后的宫颈癌风险。关于诊断评估的最佳时机几乎没有指导，关于与及时管理相关的因素的数据也很少。我们量化了2010-2018年三个不同医疗系统中异常宫颈癌筛查或监测测试结果的12个月内的阴道镜检查时间，并描述了与及时阴道镜检查相关的因素。在21-65岁的检测结果异常且需要进行阴道镜检查的患者中（n= 28，706），我们计算了在异常检测后12个月内接受阴道镜检查的比例，并使用Kaplan-Meier方法估计12个月内接受阴道镜检查的概率。在所有系统中，75.3%的患者在12个月内接受了阴道镜检查，特定部位的估计值范围为70.0- 83.0%。我们拟合混合效应多变量logistic回归模型，以确定与12个月内接受阴道镜检查相关的因素。卫生保健系统和细胞学结果严重程度是与及时阴道镜检查相关的最重要因素。我们观察到，具有更集中流程的站点具有更高的阴道镜完成比例，并且具有高等级结果的患者比具有低等级结果的患者更早地进行一致性评估。患者年龄也影响及时接受阴道镜检查，尽管这种关联因医疗保健系统和结果严重程度而异。这些数据表明，有机会进行系统级干预，以改善对异常宫颈癌检测结果的管理。
Successful cervical cancer prevention requires screening and appropriate management of abnormal test results. Management includes diagnostic evaluation and treatment, if indicated, based on cervical cancer risk after most abnormal test results. There is little guidance on the optimal timing of diagnostic evaluation, and few data exist on factors associated with timely management. We quantified time-to-colposcopy within 12 months of an abnormal cervical cancer screening or surveillance test result from 2010–2018 across three diverse healthcare systems and described factors associated with timely colposcopy. Among 21–65 year-old patients with an abnormal test result for which colposcopy was indicated (n=28,706), we calculated the proportion who received a colposcopy within 12 months of the abnormal test and used Kaplan-Meier methods to estimate the probability of colposcopy within 12 months. Across all systems, 75.3% of patients received a colposcopy within 12 months, with site-specific estimates ranging from 70.0–83.0%. We fit mixed-effects multivariable logistic regression models to identify factors associated with receipt of colposcopy within 12 months. The healthcare system and cytology result severity were the most important factors associated with of timely colposcopy. We observed that sites with more centralized processes had higher proportions of colposcopy completion, and patients with high-grade results were more consistently evaluated earlier than patients with low-grade results. Patient age also affected receipt of timely colposcopy, though this association differed by healthcare system and result severity. These data suggest opportunities for system-level interventions to improve management of abnormal cervical cancer test results.
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DOI：
10.1158/1055-9965.epi-12-0532
发表时间：
2012-10
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
影响因子：
--
作者：
Battaglia TA;Bak SM;Heeren T;Chen CA;Kalish R;Tringale S;Taylor JO;Lottero B;Egan AP;Thakrar N;Freund KM
通讯作者：
Freund KM
影响因子：
9.8
作者：
Saraiya M;Cheung LC;Soman A;Mix J;Kenney K;Chen X;Perkins RB;Schiffman M;Wentzensen N;Miller J
通讯作者：
Miller J
影响因子：
3.7
作者：
Feldman S;Cook E;Davis M;Gershman ST;Hanchate A;Haas JS;Perkins RB
通讯作者：
Perkins RB
影响因子：
7.2
作者：
Massad, L. Stewart;Einstein, Mark H.;Lawson, Herschel W.
通讯作者：
Lawson, Herschel W.
影响因子：
7.2
作者：
Kuo, Tzy-Mey;Benard, Vicki B.;Richardson, Lisa C.
通讯作者：
Richardson, Lisa C.