Projected Impact of HPV and LBC Primary Testing on Rates of Referral for Colposcopy in a Canadian Cervical Cancer Screening Program
Projected Impact of HPV and LBC Primary Testing on Rates of Referral for Colposcopy in a Canadian Cervical Cancer Screening Program
复制标题
DOI：
10.1016/s1701-2163(15)30255-3
复制
发表时间：
2015-05-01
影响因子：
1.8
通讯作者：
Ogilvie, Gina
中科院分区：
文献类型：
--
作者：
Coldman, Andrew J.;Phillips, Norm;Ogilvie, Gina
目的：评估实施原发性人乳头瘤病毒液体细胞学（LBC）筛查对不列颠哥伦比亚省筛查计划中四年阴道镜转诊率的影响。方法：我们使用来自一项RCT （HPV FOCAL）的转介阴道镜检查数据，比较每四年进行一次HPV检测和每两年进行一次LBC检测。我们还使用了25至69岁女性的常规细胞学人群筛查数据。采用任何一种试验方案对阴道镜转诊率的预测影响是用试验特定年龄的结果和筛选结果特定率加权筛选方案分布来估计的。计算了四年来阴道镜检查的累积年龄特异性转诊率。结果：在试验中，使用HPV检测最初增加了阴道镜检查的转诊率，但四年后的累积转诊率与LBC相似，除了25至29岁的女性，其中大量过量持续存在。在接受HPV检测、LBC和常规细胞学筛查的女性中，四年转诊阴道镜的比例随着年龄的增长而下降。将试验结果外推到省级筛查计划的分布中，在全省人口中实施HPV或LBC将使目前的阴道镜转诊率提高约一倍。结论：与LBC筛查相比，在25至29岁的女性中，HPV初级筛查仅增加了阴道镜的转诊率。与目前的做法相反，阴道镜检查的转诊在很大程度上是由治疗异常结果的试验方案建议驱动的，而不是由使用哪种筛查试验驱动的。
Objective: To estimate the impact of implementing primary human papilloma virus liquid-based cytology (LBC) screening on four-year rates of referral for colposcopy in the British Columbia screening program.Methods: We used data on referral for colposcopy from an RCT (HPV FOCAL) comparing HPV testing every four years with LBC testing every two years. We also used data from population screening with conventional cytology among women aged 25 to 69. The predicted effect of adoption of either trial protocol on rates of referral for colposcopy was estimated using trial age specific result and screening result-specific rates weighted by their screening program distribution. The cumulative age-specific rates of referral for colposcopy over four years were calculated.Results: Use of HPV testing initially increased rates of referral for colposcopy in the trial, but over four years the cumulative rates of referral were similar to those for LBC except in women aged 25 to 29, in whom a substantial excess persisted. Four-year rates of referral for colposcopy declined with age in women screened with HPV testing, LBC, and conventional cytology. Extrapolating the trial results to the distribution in the provincial screening program, implementation of either HPV or LBC throughout the provincial population would approximately double the current rates of referral for colposcopy.Conclusion: Compared with LBC screening, primary screening for HPV increased rates of referral for colposcopy only among women aged 25 to 29. In contrast to current practice, referral for colposcopy was largely driven by the trial protocol recommendations for the management of abnormal results and not by which screening test was used.