Human papillomavirus testing on self-sampled cervicovaginal brushes: An effective alternative to protect nonresponders in cervical screening programs
Human papillomavirus testing on self-sampled cervicovaginal brushes: An effective alternative to protect nonresponders in cervical screening programs
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DOI：
10.1002/ijc.22484
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发表时间：
2007-04-01
影响因子：
6.4
通讯作者：
Meijer, Chris J. L. M.
中科院分区：
文献类型：
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作者：
Bais, Aagje G.;van Kemenade, Folkert J.;Meijer, Chris J. L. M.
不参加宫颈筛查计划的女性患宫颈癌的风险会增加。我们对这些无反应者进行了调查，为宫颈阴道刷提供自我采样装置进行高危人乳头瘤病毒 (hrHPV) 检测会在多大程度上诱导参与，如果是这样，自我采样后前体（即 CIN2 或更严重）病变的产量会是多少。此外，与荷兰的常规计划相比，我们还评估了参与者的筛查历史以及每个检测到的高级别 CIN2 或更严重（“CIN2+”）病变的费用。无反应者接受了 hrHPV 检测设备（自我采样组，n = 2,546）或额外召回进行传统细胞学检查（对照组，n = 284）。将自我采样应答者的百分比与回忆组中的应答者进行比较。 hrHPV 阳性自我取样应答者被邀请进行细胞学检查和阴道镜检查。评估了 CIN2+ 产量和每个检测到的 CIN2+ 的成本。自我采样组的主动反应高于对照组（34.2% vs. 17.6%；p < 0.001）。与筛查参与者相比，hrHPV 阳性自我采样应答者之前有筛查史的可能性较小 (p < 0.001)，表明他们是常规无应答者。 hrHPV 患病率相似（8.0 vs. 6.8%；p = 0.11），但与筛查参与者相比，自我采样应答者的 CIN2+ 产量更高（1.67 vs. 0.97%；OR = 2.93，95% CI 1.48-5.80；p = 0.0013）。通过自我采样检测到的每个 CIN2+ 病变的成本与传统细胞学筛查计算的成本在同一范围内（8,836 欧元与 7,599 欧元）。在无反应者中进行 hrHPV 检测的自我采样是一种颇具吸引力的辅助手段，可有效提高筛查的人群覆盖率，且不会因每个检测到的 CIN2+ 病变的成本显着增加而产生不利影响。 (c) 2007 年 Wiley-Liss, Inc.
Women not attending cervical screening programs are at increased risk of cervical cancer. We investigated in these nonresponders to what extent offering self-sampling devices for cervicovaginal brushes for high-risk human papillomavirus (hrHPV) testing would induce participation and, if so, what the yield of precursor (i.e. CIN2 or worse) lesions following self-sampling would be. In addition, we assessed screening history of participants and costs per detected high-grade CIN2 or worse ("CIN2+") lesion in comparison to the regular program in the Netherlands. Nonresponders received a device for hrHPV testing (self-sampling group, n = 2,546) or an extra recall for conventional cytology (control group, n = 284). The percentage of self-sampling responders were compared with responders in the recall group. hrHPV positive self-sampling responders were invited for cytology and colposcopy. CIN2+ yield and costs per detected CIN2+ were evaluated. Active response was higher in the self-sampling than in the control group (34.2 vs. 17.6%; p < 0.001). hrHPV positive self-sampling responders were less likely to have a prior screening history than screening participants (p < 0.001), indicating that they are regular norresponders. hrHPV prevalence was similar (8.0 vs. 6.8%; p = 0.11), but CIN2+ yield was higher in self-sampling responders compared to screening participants (1.67 vs. 0.97%; OR = 2.93, 95% CI 1.48-5.80; p = 0.0013). Costs per CIN2+ lesion detected via self-sampling were in the same range as those calculated for conventional cytological screening (Euro8,836 vs. Euro7,599). Offering self-sampling for hrHPV testing in nonresponders is an attractive adjunct to effectively increase population coverage of screening without the adverse effect of markedly increased costs per detected CIN2+ lesion. (c) 2007 Wiley-Liss, Inc.