Cruickshank M E, Chambers G, Murray G, McKenzie L, Donaldson C, Andrew J, Campbell M K, Kitchener H C
Wellbeing Center for the Prevention of Cervical Cancer, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK.
Int J Gynecol Cancer. 2002 Nov-Dec;12(6):735-40. doi: 10.1046/j.1525-1438.2002.01116.x.
Changes to the present age policy of cervical screening are currently under consideration. We conducted a retrospective matched case-control study and cost analysis study to identify risk factors for the development of an abnormal smear after age 50 and to determine the impact of age-restricted cervical screening on the annual cost of the screening program. All women (229) from an 11-year birth cohort who developed an abnormal smear at age 50 or over were age-matched for two controls with negative smears. Routine screening smears taken between age 48 and 52 were tested for human papillomavirus (HPV) subtypes 16 and 18. Epidemiologic data were collected by postal questionnaire. Changes in costs under a policy of HPV testing and age-restricted screening were assessed. We found that HPV 16 status was the only independently significant risk factor for abnormal cytology after age 50 with an odds ratio of 10.26 (95% CI 1.25-84.11). A policy of early withdrawal from screening at age 50 on the basis of HPV testing would produce net cost savings. These findings suggest that HPV testing could be a valuable means of identifying the small proportion of women still at risk after 50, and of releasing health care resources.
目前正在考虑对当前的宫颈筛查年龄政策进行调整。我们进行了一项回顾性匹配病例对照研究和成本分析研究，以确定50岁后涂片异常发展的危险因素，并确定年龄限制宫颈筛查对筛查计划年度成本的影响。对来自一个11年出生队列的所有女性（229名）进行研究，这些女性在50岁及以上时涂片异常，为她们年龄匹配了两名涂片阴性的对照。对48岁至52岁之间进行的常规筛查涂片检测人乳头瘤病毒（HPV）16型和18型。通过邮寄问卷收集流行病学数据。评估了HPV检测和年龄限制筛查政策下的成本变化。我们发现，HPV 16状态是50岁后细胞学异常的唯一独立显著危险因素，比值比为10.
