Human papillomavirus vaccination and subsequent cervical cancer screening in a large integrated healthcare system
Human papillomavirus vaccination and subsequent cervical cancer screening in a large integrated healthcare system
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DOI：
10.1016/j.ajog.2016.10.006
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发表时间：
2017-02-01
影响因子：
9.8
通讯作者：
Quinn, Virginia P.
中科院分区：
文献类型：
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作者：
Chao, Chun;Silverberg, Michael J.;Quinn, Virginia P.
背景：人乳头瘤病毒疫苗接种可能会导致宫颈癌筛查意愿降低，从而可能导致筛查覆盖率和可避免的宫颈癌诊断方面的差距。目的：本研究的目的是检查人乳头瘤病毒疫苗接种与随后的宫颈癌筛查启动和遵守推荐的筛查间隔之间的关联，以发现筛查覆盖率的差距并为未来的预防工作提供信息。研究设计：在南加州 Kaiser Permanente 的 2 个不同的女性成员群体中进行了一项回顾性队列研究，这是一个大型的综合医疗保健服务系统。对 2010 年至 2013 年年满 21 岁的女性进行了巴氏筛查的启动评估。 2010 年，对 25-30 岁女性对建议筛查间隔的遵守情况进行了评估。截至 2013 年底，对所有女性进行了观察，以评估她们的筛查行为。从电子病历中获得了人乳头瘤病毒疫苗接种和巴氏筛查的历史。对推荐筛查间隔的遵守情况被测量为观察到的“最新筛查”人次的≥ 85% vs < 85%。使用多变量 Cox 和逻辑回归模型来检查疫苗接种史与筛查开始和间隔依从性之间的关联。人口统计学特征、妇科健康史、医疗保健使用情况以及女性初级保健提供者的特征均被纳入分析中，作为潜在的混杂因素。结果：筛查起始和筛查间隔依从性分析中分别纳入了 27,352 名和 41,328 名女性。与未接种疫苗的女性相比，已接种人乳头瘤病毒疫苗的女性开始筛查的调整后风险比（95% CI，1.11-1.28）、1.44（95% CI，1.34-1.53）和 1.57（95% CI，1.50-1.65）分别为 1、分别为 2 剂和 >= 3 剂。对于 1、2 和 >= 3 剂疫苗，筛查间隔依从性的调整后比值比分别为 0.93 (95% CI, 0.83-1.04)、1.73 (95% CI, 1.52-1.97) 和 2.29 (95% CI, 2.05-2.56)。 结论：接种过人乳头瘤病毒疫苗的女性在这个以社区为基础的综合医疗保健环境中，比未接种疫苗的妇女更有可能接受宫颈癌筛查。我们的研究结果强调，尽管存在基于人群的筛查计划，但仍需要对未接种疫苗的女性进行有针对性的干预措施，因为她们可能不成比例地受到宫颈癌的影响。
BACKGROUND: Human papillomavirus vaccination may result in lowered intention to be screened for cervical cancer, potentially leading to gaps in screening coverage and avoidable cervical cancer diagnoses.OBJECTIVE: The purpose of this study was to examine the association between human papillomavirus vaccination and subsequent cervical cancer screening initiation and adherence to recommended screening intervals to detect gaps in screening coverage and inform future prevention efforts.STUDY DESIGN: A retrospective cohort study was conducted in 2 distinct cohorts of female members of Kaiser Permanente Southern California, which is a large integrated healthcare delivery system. Papanicolaou screening initiation was evaluated in women who reached 21 years from 2010-2013. Adherence to recommended screening intervals was evaluated in women who were 25-30 years old in 2010. All women were observed to the end of 2013 for the evaluation of their screening behaviors. History of human papillomavirus vaccination and Papanicolaou screening were obtained from electronic medical records. Adherence to recommended screening intervals was measured as >= 85% vs < 85% of the observed " screening up-to-date" person-time. Multivariable Cox and logistic regression models were used to examine associations between vaccination history and screening initiation and interval adherence. Demographic characteristics, gynecologic health history, healthcare use, and characteristics of women's primary care providers were included as potential confounders in the analyses.RESULTS: There were 27,352 and 41,328 women included in the screening initiation and screening interval adherence analyses, respectively. In comparison with unvaccinated women, adjusted hazard ratios (95% confidence intervals [CIs]) for screening initiation among women who had been vaccinated against human papillomavirus were 1.19 (95% CI, 1.11-1.28), 1.44 (95% CI, 1.34-1.53), and 1.57 (95% CI, 1.50-1.65) for 1, 2, and >= 3 doses, respectively. Adjusted odds ratios for screening interval adherence were 0.93 (95% CI, 0.83-1.04), 1.73 (95% CI, 1.52-1.97), and 2.29 (95% CI, 2.05-2.56), for 1, 2, and >= 3 doses, respectively.CONCLUSION: Women who had been vaccinated against human papillomavirus in this community-based, integrated healthcare setting were more likely to be screened for cervical cancer than were unvaccinated women. Our findings underscore the need for targeted interventions among unvaccinated women who may be disproportionally affected by cervical cancer, despite the presence of population-based screening programs.