Safety of extending screening intervals beyond five years in cervical screening programmes with testing for high risk human papillomavirus: 14 year follow-up of population based randomised cohort in the Netherlands
Safety of extending screening intervals beyond five years in cervical screening programmes with testing for high risk human papillomavirus: 14 year follow-up of population based randomised cohort in the Netherlands
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DOI：
10.1136/bmj.i4924
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发表时间：
2016-10-04
影响因子：
105.7
通讯作者：
Berkhof, Johannes
中科院分区：
文献类型：
--
作者：
Dijkstra, Maaike G.;van Zummeren, Marjolein;Berkhof, Johannes
目的：为荷兰基于人乳头瘤病毒（HPV）的宫颈筛查计划延长筛查间隔超过5年提供早期风险评估。设计：对来自POBASCAM随机试验的人群随机队列进行为期14年的随访。背景在荷兰组织子宫颈筛查，基于三轮筛查方案（每五年进行一轮）。参与POBASCAM试验的339名年龄29-61岁、HPV阴性和/或细胞学检测阴性的女性。干预：随机分配妇女接受HPV和细胞学联合检测（干预）或仅接受细胞学检测（对照组），并进行相应的管理。主要观察指标：宫颈癌和宫颈上皮内瘤变（CIN） 3级或以上（CIN3+）的累积发病率。与年龄的关联以发病率比表示。在HPV阳性的女性中，估计阴性细胞学、HPV 16/18型基因分型和/或重复细胞学后CIN3+发病率的降低。结果干预组HPV阴性妇女3轮筛查后宫颈癌累积发病率（0.09%）和CIN3+累积发病率（0.56%）与对照组细胞学阴性妇女2轮筛查后累积发病率（分别为0.09%和0.69%）相似。宫颈癌和CIN3+的危险比分别为0.97（95%可信区间0.41 ~ 2.31，P=0.95）和0.82 （0.62 ~ 1.09，P=0.17）。CIN3+发生率为72.2%（95%可信区间61.6% ~ 79.9%，5年），应实施风险分层。
OBJECTIVESTo provide an early risk assessment of extending screening intervals beyond five years for a human papillomavirus (HPV) based cervical screening programme in the Netherlands.DESIGN14 year follow-up of a population based randomised cohort from the POBASCAM randomised trial.SETTINGOrganised cervical screening in the Netherlands, based on a programme of three screening rounds (each round done every five years).PARTICIPANTS43 339 women aged 29-61 years with a negative HPV and/or negative cytology test participating in the POBASCAM trial.INTERVENTIONSWomen randomly assigned to HPV and cytology co-testing (intervention) or cytology testing only (control), and managed accordingly.MAIN OUTCOME MEASURESCumulative incidence of cervical cancer and cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+). Associations with age were expressed as incidence rate ratios. In HPV positive women, reductions in CIN3+ incidence after negative cytology, HPV type 16/18 genotyping, and/or repeat cytology were estimated.RESULTSThe cumulative incidence of cervical cancer (0.09%) and CIN3+ (0.56%) among HPV negative women in the intervention group after three rounds of screening were similar to the cumulative among women with negative cytology in the control group after two rounds (0.09% and 0.69%, respectively). Cervical cancer and CIN3+ risk ratios were 0.97 (95% confidence interval 0.41 to 2.31, P=0.95) and 0.82 (0.62 to 1.09, P=0.17), respectively. CIN3+ incidence was 72.2% (95% confidence interval 61.6% to 79.9%, Pfive years) should be implemented with risk stratification.