A population-based evaluation of cervical screening in the United States: 2008-2011.
A population-based evaluation of cervical screening in the United States: 2008-2011.
复制标题
美国宫颈筛查的人群评估：2008-2011 年。
DOI：
10.1158/1055-9965.epi-13-0973
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发表时间：
2014-05
期刊：
影响因子：
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通讯作者：
New Mexico HPV Pap Registry Steering Committee
中科院分区：
文献类型：
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作者：
Cuzick J;Myers O;Hunt WC;Robertson M;Joste NE;Castle PE;Benard VB;Wheeler CM;New Mexico HPV Pap Registry Steering Committee
宫颈癌筛查消耗大量的资源，但很少有人知道在美国的利用或遵守指南的建议。为了描述人口筛查的覆盖率、利用率和结果，并检查2008年至2011年的时间趋势，对居住在新墨西哥州的妇女（511，381名妇女的981，063次检测）的宫颈细胞学报告进行了评价。从2008年至2011年，所有年龄段的宫颈筛查利用率都有所下降，但年轻女性尤其如此，15-20岁的女性减少了三分之二。94%的25-29岁妇女在48个月内接受了筛查，但年龄越大，筛查覆盖率越低，45-49岁为69%，60-64岁为55%。与2008年相比，2011年筛选试验之间的间隔显著更长（风险比= 1.23，95% CI = 1.22-1.24），尽管最常见的重新筛选间隔为13个月。2011年，91.9%的21-65岁妇女的筛查结果为阴性，6.6%显示轻微异常，1.0%显示高度异常。随着时间的推移，高度异常率相对恒定，但轻微异常和非典型细胞不能排除高度（ASC-H）正在增加。这项基于人口的子宫颈检查评价显示，40岁以下的覆盖率很高，但老年妇女的覆盖率较低。21岁以下的筛查越来越不常见，筛查间隔时间正在延长，反映了国家筛查指南的更新。评估宫颈筛查间隔和人群结果对于准确估计改变建议和接种人乳头瘤病毒感染疫苗的影响和有效性至关重要。
Cervical screening consumes substantial resources, but little is known about utilization in the United States or compliance with guideline recommendations. To describe population screening coverage, utilization and outcomes and examine time trends from 2008 to 2011, cervical cytology reports from women residing in New Mexico (981,063 tests from 511,381 women) were evaluated. From 2008–2011 cervical screening utilization decreased at all ages, but especially in younger women, with a two-thirds reduction at ages 15–20 years. 94% of women aged 25–29 years were screened within 48 months but coverage decreased at older ages, to 69% at 45–49 years and 55% at 60–64 years. Intervals between screening tests were significantly longer in 2011 compared to 2008 (hazard ratio = 1.23, 95% CI = 1.22–1.24) although the commonest rescreening interval was 13 months. In 2011, 91.9% of screening tests for women aged 21–65 years were negative, 6.6% showed minor abnormalities, and 1.0% high grade abnormalities.. High grade abnormality rates were relatively constant over time, but minor abnormalities and atypical cells cannot rule out high-grade (ASC-H) were increasing. This population-based evaluation of cervical screening shows high coverage under the age of 40 years but lower levels in older women. Screening under age 21 years is becoming less common and screening intervals are lengthening, reflecting updates in national screening guidelines. Assessment of cervical screening intervals and population outcomes is essential for accurately estimating the impact and effectiveness of changing recommendations and vaccination against human papillomavirus infections.