Cervical cancer screening after age 65 in the era of HPV testing: estimating benefits and harms of screening cessation and continuation

HPV检测时代65岁以后的宫颈癌筛查：评估停止和继续筛查的利弊

• 批准号: 10670421
• 负责人: GEORGE F SAWAYA
• 金额: $ 65.48万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10670421
• 关键词: Address; Adoption; Age; Aging; American Cancer Society; Area; Biometry; California; Cervical; Cervical Cancer Screening; Cervix Uteri; Cessation of life; Cohort Studies; Communicable Diseases; Cost Effectiveness Analysis; Cytology; Data; Decision Modeling; Diagnostic Procedure; Discipline of obstetrics; Effectiveness; Elderly; Electronic Health Record; Enrollment; Equilibrium; Future; Geriatrics; Guidelines; Gynecology; HPV-High Risk; Health system; Human Papillomavirus; Hysterectomy; Incidence; Influentials; Integrated Health Care Systems; Interview; Knowledge; Life Expectancy; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Methods; Modeling; Operative Surgical Procedures; Outcome; Patients; Population; Procedures; Process; Public Health; Quality-Adjusted Life Years; Recommendation; Recording of previous events; Research; Risk; Sampling; Screening for cancer; Stable Populations; Stage at Diagnosis; Test Result; Testing; United States; United States Preventative Services Task Force; Unnecessary Procedures; Validation; Woman; Women' s Group; cancer diagnosis; cancer epidemiology; cancer risk; cervical cancer prevention; clinically significant; evidence base; experience; high risk; human old age (65+); improved; medical complication; member; mortality; older women; psychologic; randomized trial; screening; screening guidelines; secondary analysis; success

Project Summary Cervical cancer screening represents a remarkable success story that has led to profound reductions in cancer incidence and mortality in the United States (US), yet fundamental questions about screening cessation remain. For the last 25 years, the US Preventive Services Task Force (USPSTF) has recommended screening cessation at age 65 in those deemed to have been adequately screened. The increase in life expectancy over the last 25 years, however, raises questions about whether healthy, well-screened women over age 65 should continue screening. In fact, an estimated 21% of cervical cancer cases and 35% of deaths in the US occur after age 65. Screening older people for cancer, however, involves a judicious consideration of the balance between benefits and harms. For example, cervical cancer prevention through screening is only achieved by performing surgical procedures on the cervix, including hysterectomies, which may pose a higher risk of major medical complications for older women. Because up to 60% of women have not met the criteria to end screening at age 65, an estimated 1,700,000 women turning age 65 each year in the US can be expected to continue screening. In its most recent guideline, the USPSTF stated that research is needed to elucidate the balance of benefits and harms in various groups of women over age 65. The aims of this proposal will fill significant evidence gaps concerning the benefits and harms of cervical cancer screening after age 65. Aim 1 will involve a cohort study of about 280,000 women over 65 who were long-term members of two large health systems during 2005-2022 to investigate cervical cancer incidence, stage at cancer diagnosis, and cancer mortality by screening history documented ages 55 to 65. We will also use causal inference methods to emulate a randomized trial using observational data to estimate the effectiveness of screening after age 65 on cancer outcomes. Aim 2 involves a cohort study of women screened after age 65 to investigate harms, including the incidence and predictors of medical complications resulting from diagnostic procedures and surgical interventions. We will also conduct qualitative interviews in a sample of women to evaluate the personal experiences of women who continue with the screening process after age 65. Aim 3 will involve the enumeration of actual screening outcomes of 33,000 women screened after age 65 to inform a decision analytic model that will estimate benefits and harms of screening continuation after age 65 compared with screening cessation. We have assembled an ideal study team with expertise in obstetrics/gynecology, infectious disease, cancer epidemiology, cancer screening decision modeling, biostatistics, and geriatrics. Completion of this proposal’s aims will fill important gaps and move the field forward by providing evidence to make cervical cancer screening guidelines that better balance benefits and harms in older women.

项目摘要 宫颈癌筛查是一个显著的成功案例，大大降低了癌症的发病率。 美国(US)的发病率和死亡率，但关于停止筛查的基本问题 留下来。在过去的25年里，美国预防服务工作组(USPSTF)一直建议进行筛查 那些被认为已经进行了充分筛查的人在65岁时停止治疗。与过去相比，预期寿命的增加 然而，在过去的25年里，人们提出了这样的问题：65岁以上的健康、筛查良好的女性是否应该 继续筛选。事实上，据估计，美国21%的宫颈癌病例和35%的死亡病例发生在 65岁。然而，对老年人进行癌症筛查涉及到明智地考虑两者之间的平衡 利与弊。例如，通过筛查预防宫颈癌只能通过执行 对宫颈进行手术，包括子宫切除术，这可能会带来更高的重大医疗风险 老年女性的并发症。因为高达60%的女性没有达到在年龄结束筛查的标准 65岁，据估计，美国每年有170万年满65岁的女性将继续筛查。 在其最新的指导方针中，USPSTF表示，需要进行研究来阐明利益和 对65岁以上的不同女性群体造成伤害。这项提案的目的将填补重大的证据空白 关于65岁后宫颈癌筛查的好处和坏处。目标1将涉及一项队列研究 2005-2022年间，约28万名65岁以上的妇女是两个大型卫生系统的长期成员 通过筛查史调查宫颈癌发病率、癌症诊断阶段和癌症死亡率 有记录的年龄在55岁到65岁之间。我们还将使用因果推理方法来模拟一个随机试验 用于评估65岁后筛查对癌症预后的有效性的观察数据。目标2涉及一个 对65岁以上妇女进行筛查以调查危害的队列研究，包括高血压的发生率和预测因素 由诊断程序和外科干预引起的医疗并发症。我们还将进行 对女性样本进行定性访谈，以评估继续使用 65岁以后的筛查程序。目标3将涉及统计33,000个实际筛查结果 对65岁以后的女性进行筛查，以提供决策分析模型，以评估以下各项的好处和危害 65岁后继续筛查与停止筛查的比较。我们已经组织了一项理想的研究 在产科/妇科、传染病、癌症流行病学、癌症筛查方面拥有专业知识的团队 决策建模、生物统计学和老年学。这项提案的目标的完成将填补重要的空白和 通过提供证据使宫颈癌筛查指南更好地平衡 对老年妇女的好处和坏处。