Risk of cervical precancer and cancer among uninsured and underserved women from 2009 to 2017.
Risk of cervical precancer and cancer among uninsured and underserved women from 2009 to 2017.
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DOI：
10.1016/j.ajog.2020.10.001
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发表时间：
2021-04
影响因子：
9.8
通讯作者：
Miller J
中科院分区：
文献类型：
--
作者：
Saraiya M;Cheung LC;Soman A;Mix J;Kenney K;Chen X;Perkins RB;Schiffman M;Wentzensen N;Miller J
在美国，管理女性宫颈癌前期的新指南直接使用风险来指导正在接受筛查的个体的临床行动。这些基于风险的管理指南以前仅基于大型综合医疗保健系统的风险。我们在这里提供了没有持续保险覆盖的低收入妇女的代表性数据，以告知2019年指南并确保适用性。我们在服务不足的女性中检查了人乳头瘤病毒和细胞学检查后发生高级别癌前病变的风险，并评估了2019年指南对这一人群的适用性。我们检查了2009年至2017年参加疾病控制与预防中心国家乳腺癌和宫颈癌早期检测项目的363546名妇女的宫颈癌筛查和随访数据。我们使用患病率-发病率混合模型估计宫颈上皮内病变3级或癌症的直接（普遍）风险。评估人乳头瘤病毒和细胞学结果的每种组合的风险，并根据筛查史进行分层。我们将这些风险与新的基于风险的管理指南中公布的估计进行了比较。最新筛查的女性，定义为在过去5年内接受细胞学筛查的女性，具有3级或更高级别宫颈上皮内瘤变的直接风险，与Kaiser Permanente北加州的女性相似，其数据用于制定管理指南。然而，在疾病控制和预防中心的国家乳腺癌和宫颈癌早期检测项目中，如果女性从未接受过筛查或没有及时进行筛查，她们的直接风险更大。新的宫颈风险管理指南适用于在美国进行最新筛查的保险不足和未保险的低收入妇女。在接受人乳头瘤病毒阳性、细胞学检查结果较高、从未接受过筛查或未及时进行宫颈癌筛查的妇女中观察到风险增加，因此在管理指南中建议对这些妇女立即进行治疗。
New guidelines for managing cervical precancer among women in the United States use risk directly to guide clinical actions for individuals who are being screened. These risk-based management guidelines have previously only been based on risks from a large integrated healthcare system. We present here data representative of women of low income without continuous insurance coverage to inform the 2019 guidelines and ensure applicability. We examined the risks of high-grade precancer after human papillomavirus and cytology tests in underserved women and assessed the applicability of the 2019 guidelines to this population. We examined cervical cancer screening and follow-up data among 363,546 women enrolled in the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program from 2009 to 2017. We estimated the immediate (prevalent) risks of cervical intraepithelial lesion grade 3 or cancer by using prevalence-incidence mixture models. Risks were estimated for each combination of human papillomavirus and cytology result and were stratified by screening history. We compared these risks with published estimates used in new risk-based management guidelines. Women who were up-to-date with their screening, defined as being screened with cytology within the past 5 years, had immediate risks of cervical intraepithelial neoplasia grade 3 or higher similar to that of women at Kaiser Permanente Northern California, whose data were used to develop the management guidelines. However, women in the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program had greater immediate risks if they were never screened or not up-to-date with their screening. New cervical risk–based management guidelines are applicable for underinsured and uninsured women with a low income in the United States who are up-to-date with their screening. The increased risk observed here among women who received human papillomavirus–positive, high-grade cytology results, who were never screened, or who were not up-to-date with their cervical cancer screening, led to a recommendation in the management guidelines for immediate treatment among these women.
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影响因子：
120.7
作者：
Wright, TC;Cox, JT;Wilkinson, EJ
通讯作者：
Wilkinson, EJ
影响因子：
7.2
作者：
Massad, L. Stewart;Einstein, Mark H.;Lawson, Herschel W.
通讯作者：
Lawson, Herschel W.
影响因子：
2
作者：
Cheung, Li C.;Pan, Qing;Katki, Hormuzd A.
通讯作者：
Katki, Hormuzd A.
影响因子：
3.7
作者：
Cheung, Li C.;Egemen, Didem;Schiffman, Mark
通讯作者：
Schiffman, Mark
影响因子：
6.2
作者：
Lee, Nancy C.;Wong, Faye L.;Stokes-Townsend, George-Ann
通讯作者：
Stokes-Townsend, George-Ann