Exposure Definition in Case-Control Studies of Cervical Cancer Screening: A Systematic Literature Review.
Exposure Definition in Case-Control Studies of Cervical Cancer Screening: A Systematic Literature Review.
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DOI：
10.1158/1055-9965.epi-21-0376
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发表时间：
2021-12
期刊：
影响因子：
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通讯作者：
Sasieni P
中科院分区：
文献类型：
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作者：
Castanon A;Kamineni A;Elfström KM;Lim AWW;Sasieni P
评估宫颈筛查有效性的第一步是确定筛查的暴露程度。我们的目的是描述在宫颈筛查有效性研究中使用的筛查暴露定义的谱。这项系统性综述包括以人群为基础的筛查环境中的病例对照研究。结果是宫颈癌的发生率。检索2012年1月1日至2018年12月6日的3个电子数据库。2012年前的文章是从之前的审查中确定的。定性综合侧重于描述文献中报告的筛查暴露定义，以及可能对筛查和宫颈癌之间的联系产生影响的方法学差异。纳入41项病例对照研究。确定了六种筛查暴露定义。当筛查暴露被定义为曾经测试过时，宫颈癌风险平均降低了66%，自上次阴性测试以来的时间平均降低了77%，在之前的两次或两次以上测试后降低了79%。方法学差异包括参照组的组成以及诊断和/或症状试验是否被排除在分析之外。需要标准化暴露定义的共识指南，以确保宫颈癌筛查的评估能够准确地衡量从细胞学过渡到基于人类乳头瘤病毒的筛查的影响，并允许在不同计划之间进行比较。
The first step in evaluating the effectiveness of cervical screening is defining exposure to screening. Our aim was to describe the spectrum of screening exposure definitions used in studies of the effectiveness of cervical screening. This systematic review included case-control studies in a population-based screening setting. Outcome was incidence of cervical cancer. Three electronic databases were searched from January 1, 2012 to December 6, 2018. Articles prior to 2012 were identified from a previous review. The qualitative synthesis focused on describing screening exposure definitions reported in the literature and the methodologic differences that could have an impact on the association between screening and cervical cancer. Forty-one case–control studies were included. Six screening exposure definitions were identified. Cervical cancer risk on average decreased by 66% when screening exposure was defined as ever tested, by 77% by time since last negative test, and by 79% after two or more previous tests. Methodologic differences included composition of the reference group and whether diagnostic and/or symptomatic tests were excluded from the analysis. Consensus guidelines to standardize exposure definitions are needed to ensure evaluations of cervical cancer screening can accurately measure the impact of transitioning from cytology to human papillomavirus–based screening and to allow comparisons between programs.