van Oortmarssen G J, Habbema J D
Department of Public Health and Social Medicine, Medical Faculty, Erasmus University, Rotterdam, The Netherlands.
Br J Cancer. 1991 Sep;64(3):559-65. doi: 10.1038/bjc.1991.350.
Data from the screening programme in British Columbia are used to test hypotheses about the natural history of cervical cancer, especially about progression and regression of preclinical lesions (dysplasia and carcinoma in situ). Three models are considered. A model without regression does not give an adequate fit of the data (P less than 0.001), and results in an implausible estimate of 33 years for the mean duration of pre-invasive lesions. A model with an equal regression rate at all ages still does not result in a good reproduction of the data. A good fit is achieved for a model with different regression rates in lesions that develop under and over age 34. Under age 34, 84% of the new lesions will regress spontaneously, with a 95% confidence interval of 76-92% regression. Over age 34, we estimate that 40% of the new lesions will regress. The average duration of dysplasia + CIS is 11.8 years, and the sensitivity of the Pap-smear is 80%. It is concluded that a considerable proportion of pre-invasive lesions in young women do not progress. The findings about progression and duration of pre-invasive lesions do not support the still prevailing tendency of frequently making Pap smears in young women.
来自不列颠哥伦比亚省筛查项目的数据被用于检验关于宫颈癌自然史的假设，尤其是关于临床前病变（发育异常和原位癌）的进展和消退情况。考虑了三种模型。一种无消退的模型不能很好地拟合数据（P小于0.001），并得出侵袭前病变平均持续时间为33年的不合理估计。一种所有年龄回归率相同的模型仍然不能很好地再现数据。对于34岁以下和34岁以上发生的病变具有不同回归率的模型，能实现良好的拟合。34岁以下，84%的新病变会自发消退，95%置信区间的消退率为76 - 92%。34岁以上，估计40%的新病变会消退。发育异常 + 原位癌的平均持续时间为11.8年，巴氏涂片的敏感性为80%。得出的结论是，年轻女性中相当一部分侵袭前病变不会进展。关于侵袭前病变进展和持续时间的研究结果不支持目前仍然普遍存在的在年轻女性中频繁进行巴氏涂片检查的倾向。
