Reassurance Against Future Risk of Precancer and Cancer Conferred by a Negative Human Papillomavirus Test
Reassurance Against Future Risk of Precancer and Cancer Conferred by a Negative Human Papillomavirus Test
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DOI：
10.1093/jnci/dju153
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发表时间：
2014-08-01
影响因子：
10.3
通讯作者：
Kinney, Walter K.
中科院分区：
文献类型：
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作者：
Gage, Julia C.;Schiffman, Mark;Kinney, Walter K.
美国正在考虑每 3 年进行一次初次人类乳头瘤病毒 (HPV) 检测（不同时进行巴氏涂片检测），作为两种推荐的宫颈癌筛查策略的替代方案：每 3 年进行一次初次巴氏涂片检测，或每 5 年进行一次并行巴氏涂片和 HPV 检测（“共同检测”）。使用逻辑回归和威布尔生存模型，我们自 2003 年以来在北加州 Kaiser Permanente 的常规筛查中对 1 011 092 名 30 至 64 岁的女性进行了 HPV 阴性和/或巴氏涂片阴性检测，使用三种策略估计并比较了癌症和宫颈上皮内瘤变 3 级或更严重 (CIN3+) 的风险。所有统计检验都是双边的。 HPV 阴性结果后的三年风险低于巴氏涂片阴性结果后的三年风险（CIN3+ = 0.069% vs 0.19%，P < .0001；癌症 = 0.011% vs 0.020%，P < .0001）以及 HPV 阴性/巴氏涂片阴性结果后的 5 年风险（CIN3+ = 0.069% vs 0.11%，P < .0001；癌症 = 0.011% vs 0.014%，P = .21）。这些发现表明初级 HPV 检测值得考虑作为宫颈筛查的另一种替代方法。
Primary human papillomavirus (HPV) testing (without concurrent Pap tests) every 3 years is under consideration in the United States as an alternative to the two recommended cervical cancer screening strategies: primary Pap testing every 3 years, or concurrent Pap and HPV testing ("cotesting") every 5 years. Using logistic regression and Weibull survival models, we estimated and compared risks of cancer and cervical intraepithelial neoplasia grade 3 or worse (CIN3+) for the three strategies among 1 011 092 women aged 30 to 64 years testing HPV-negative and/or Pap-negative in routine screening at Kaiser Permanente Northern California since 2003. All statistical tests were two sided. Three-year risks following an HPV-negative result were lower than 3-year risks following a Pap-negative result (CIN3+ = 0.069% vs 0.19%, P < .0001; Cancer = 0.011% vs 0.020%, P < .0001) and 5-year risks following an HPV-negative/Pap-negative cotest (CIN3+ = 0.069% vs 0.11%, P < .0001; Cancer = 0.011% vs 0.014%, P = .21). These findings suggest that primary HPV testing merits consideration as another alternative for cervical screening.