Gaps in the screening process for women diagnosed with cervical cancer in four diverse US health care settings.
Gaps in the screening process for women diagnosed with cervical cancer in four diverse US health care settings.
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在人乳头瘤病毒（HPV）检测增加的时代，诊断为宫颈癌的妇女在宫颈癌筛查过程中的潜在护理差距尚未得到广泛评估。2010年至2014年间，在四个研究地点被诊断患有宫颈癌的年龄在21岁至65岁之间的女性被纳入其中。在宫颈癌诊断前0.5至4年确定筛查史。我们确定了每位女性筛查史中潜在的护理缺口，并将其分为三种相互排斥的类型：缺乏筛查试验、筛查试验失败和诊断/治疗护理缺口。护理间隙的分布按分期、组织学和研究地点分列。使用多变量名义逻辑回归来检验人口统计学和癌症特征以及护理差距类型之间的关系。在499名接受评估的女性中，46%的女性在检查的时间窗口内缺乏筛查测试，31%的女性经历了筛查测试失败，22%的女性经历了诊断/治疗护理差距。超过一半的晚期癌症和鳞状细胞癌患者缺乏筛查，而局限性癌症和腺癌患者的这一比例分别为31%和24%。与30-39岁的女性相比，21-29岁的女性诊断时更容易经历筛查试验失败和诊断/治疗护理差距，而50-65岁的女性更有可能缺乏筛查试验。我们的研究结果表明，持续需要针对未筛查和筛查不足的女性开发干预措施，并改善接受宫颈癌筛查和诊断随访的女性腺癌的检测和诊断。在2010 - 2014年人类乳头瘤病毒检测增加的时代，我们研究了499名诊断为宫颈癌的妇女在宫颈癌筛查过程中的潜在护理缺口。在这些妇女中，46%的人在检查的时间窗口内缺乏筛查试验，31%的人经历了筛查试验失败，22%的人经历了诊断/治疗护理差距。我们的研究结果表明，持续需要针对未筛查和筛查不足的女性开发干预措施，并改善接受筛查和诊断随访的女性的检测和诊断。
Potential care gaps in the cervical cancer screening process among women diagnosed with cervical cancer in an era with increased human papillomavirus (HPV) testing have not been extensively evaluated. Women diagnosed with cervical cancer between ages 21 and 65 at four study sites between 2010 and 2014 were included. Screening histories were ascertained from 0.5 to 4 years prior to cervical cancer diagnosis. We identified potential care gaps in the screening history for each woman and classified them into one of three mutually exclusive types: lack of a screening test, screening test failure, and diagnostic/treatment care gap. Distributions of care gaps were tabulated by stage, histology, and study site. Multivariable nominal logistic regression was used to examine the associations between demographic and cancer characteristics and type of care gap. Of 499 women evaluated, 46% lacked a screening test in the time window examined, 31% experienced a screening test failure, and 22% experienced a diagnostic/treatment care gap. More than half of the women with advanced cancer and squamous cell carcinoma lacked a screening test compared to 31% and 24% of women with localized cancer and adenocarcinoma, respectively. Women aged 21–29 at diagnosis were more likely to experience screening test failure and diagnostic/treatment care gap, while those aged 50–65 were more likely to lack a screening test, compared to women aged 30–39. Our findings demonstrate a continuing need to develop interventions targeting unscreened and under‐screened women and improve detection and diagnosis of adenocarcinoma in women undergoing cervical cancer screening and diagnostic follow‐up. We examined potential care gaps in the cervical cancer screening process among 499 women diagnosed with cervical cancer in the era with increased human papillomavirus testing (2010‐2014). Of these women, 46% lacked a screening test in the time window examined, 31% experienced a screening test failure, and 22% experienced a diagnostic/treatment care gap. Our findings demonstrate a continuing need to develop interventions targeting unscreened and under‐screened women and improve detection and diagnosis in women undergoing screening and diagnostic follow‐up.