Surveillance Strategies Following Treatment for CIN

描述(申请人提供)：虽然现在发达国家的宫颈癌比以前不那么常见，但2003年美国的宫颈癌预计将导致12,200例新病例和4,100例死亡。这些相对较低的发病率归因于宫颈癌筛查和宫颈上皮内瘤变(CIN)治疗的成功。在发达国家进一步降低宫颈癌的发病率和死亡率，同时避免不必要的手术和节约资源，是临床医生和卫生政策制定者面临的挑战。最近，从建议终身每年一次的宫颈癌筛查转向每两到三年进行一次持续筛查，这是努力应对这一挑战的一个例子。最近对美国的估计表明，每年有100多万妇女被诊断为低级别肿瘤(CIN I)，而大约500,000名妇女将有较高级别的病变(CIN 2或CIN 3)。后续战略必须在发现和治疗持续性或复发性病变以及潜在的过度使用程序和资源之间取得平衡。最近发表的ALTS试验结果导致了对CIN的管理和后续行动的建议。这些建议包括治疗后每隔4至6个月进行一次随访，直到获得三项细胞学阴性结果，然后进行年度筛查。然而，每年筛查的持续时间仍未确定，治疗后CIN或浸润性癌症复发的长期风险和时间模式仍不清楚。尚未对这些建议的相对成本效益进行评估。鉴于每年被诊断为宫颈上皮内瘤变的妇女人数众多，随着时间的推移，相当数量的妇女将被分配到长期的年度细胞学检查，以进行治疗后的监测。我们的研究将检验CIN复发的长期风险，以及风险随时间的变化，该队列来自全面的、以人群为基础的数据集。基于这些数据和以前的工作，我们将进行成本-效果分析，以比较对接受过CIN评估和治疗的女性进行长期随访的策略。来自队列研究和文献系统回顾的数据将用于复发风险，成本将通过临床路径编码进行估计，从不同人群获得的效用将应用于先前验证的马尔可夫模型。将对治疗后监测的替代战略进行评估。

DESCRIPTION (provided by applicant): Though now less common in developed countries than previously, in 2003 cervical cancer is projected to result in 12,200 new cases and 4,100 deaths in the United States. These relatively low rates are attributed to the success of cervical cancer screening and treatment of cervical intraepithelial neoplasia (CIN). To reduce further the incidence and mortality of cervical cancer in developed countries while avoiding unnecessary procedures and conserving resources is a challenge that confronts clinicians and health policy makers. The recent move away from recommending lifelong annual cervical cancer screening towards consistent screening every two to three years is one example of an effort to meet this challenge. Recent estimates for the US indicate that more than one million women are diagnosed with low-grade neoplasia (CIN I) annually, and that about 500,000 women will have higher-grade lesions (CIN 2 or CIN 3). Follow-up strategies must strike a balance between finding and treating persistent or recurrent lesions and potential overuse of procedures and resources. The recent publication of the findings from the ALTS trial has led to recommendations for the management and follow-up of CIN. These recommendations include follow-up after treatment at 4 to 6 month intervals until three negative cytology results are obtained, followed by annual screening. The duration of annual screening remains unspecified, however, and the long-term risk and time patterns of recurrence of CIN or invasive cancer after treatment remain unclear. The relative costeffectiveness of these recommendations has not been evaluated. Given the large number of women diagnosed with CIN every year, over time a substantial number of women will be assigned to long-term annual cytology for post-treatment surveillance. Our study will examine the long-term risks of recurrent CIN and changes in risk over time in a cohort drawn from a comprehensive, population-based dataset. Based on this data and previous work, we will conduct a cost-effectiveness analysis to compare strategies for longterm follow-up of women who have undergone evaluation and treatment of CIN. Data from the cohort study and a systematic review of the literature will be used for recurrence risks, costs will be estimated by coding of clinical pathways, and utilities obtained from diverse populations will be applied to a previously validated Markov model. Alternative strategies for post-treatment surveillance will be evaluated.