Estimating the efficacy of screening by auditing smear histories of women with and without cervical cancer. The National Co-ordinating Network for Cervical Screening Working Group.
Estimating the efficacy of screening by auditing smear histories of women with and without cervical cancer. The National Co-ordinating Network for Cervical Screening Working Group.
复制标题
通过审核患有和不患有宫颈癌的女性的涂片史来评估筛查的效果。
DOI：
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发表时间：
1996
影响因子：
8.8
通讯作者：
The National Co
中科院分区：
文献类型：
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作者：
P. Sasieni;J. Cuzick;E. Lynch;The National Co
在英格兰、威尔士和苏格兰的24个自我选择的地区卫生当局和卫生委员会中，将1992年诊断出的所有348名浸润性宫颈癌妇女的筛查史与677名年龄和居住地匹配的对照进行比较。对照组从家庭健康服务管理局（FHSA）登记册中随机选择。筛查历史，包括患者癌症诊断日期前所有涂片的日期和结果，由FHSA计算机和实验室记录确定。我们估计，如果以前没有进行筛查，1992年参与地区的宫颈癌病例数将增加57%（95%置信区间28 - 86%）。在70岁以下的女性中，这一比例约高出75%（31 - 115%）。从这个试点的结果外推表明，在1992年，筛查在英国预防了1100至3900例浸润性宫颈癌。与对照组相比，患有1B期癌症或更严重癌症的女性更可能没有既往筛查记录：根据当前（5年一次的筛查）指南，这些70岁以下的女性中有47%接受了充分的筛查，而匹配的对照组为75%。在所有70岁以下的患者中，有13%的人有筛查史，表明对需要阴道镜检查的涂片随访不足。筛查早于诊断的微创病例的比例与对照组的比例相似。分期和年龄之间有很强的相关性：35岁以下女性中56%的癌症是微创的，而65岁或以上女性中只有9%。涂片阴性后的"相对保护"在头12个月最大，到第五年年底下降。这些数据表明，完全遵守目前的指导方针可能会防止另外1250例病例，但需要采取额外措施来防止70岁以下妇女的2300例剩余病例中的一些病例。
The screening histories of all 348 women with invasive cervical cancer diagnosed in 1992 in 24 self-selected district health authorities and health boards in England, Wales and Scotland were compared with those of 677 age- and residency-matched controls. The controls were randomly selected from the family health services authority (FHSA) register. Screening histories, comprising the dates and results of all smears taken before the date of diagnosis of the patient's cancer, were determined from the FHSA computer and laboratory records. We estimate that the number of cases of cervical cancer in participating districts in 1992 would have been 57% (95% confidence interval 28-86%) greater if there had been no previous screening. In women under the age of 70 it would have been approximately 75% (31-115%) greater. Extrapolation of the results from this pilot suggests that screening prevented between 1100 and 3900 cases of invasive cervical cancer in the UK in 1992. Women with stage 1B cancer or worse were more likely to have no record of previous screening than controls: 47% of these women under the age of 70 had been adequately screened according to current (5 yearly screening) guidelines, compared with 75% of matched controls. Thirteen per cent of all patients under age 70 had screening histories indicative of inadequate follow-up of smears requiring colposcopy. The proportion of microinvasive cases with screening predating diagnosis was similar to the proportion of controls. There was a strong correlation between stage and age: 56% of cancers in women under 35 were microinvasive compared with just 9% in women 65 years or over. The 'relative protection' following a negative smear was greatest in the first 12 months and fell off towards the end of the fifth year. These data suggest that full adherence to current guidelines could perhaps have prevented another 1250 cases, but additional steps would have been required to prevent some of the 2300 remaining cases in women under the age of 70.