From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Regional Laboratory, Kaiser Permanente Northern California, Berkley, California; Women's Health Research Institute and Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, California; and Information Management Services, Silver Spring, Maryland.
Obstet Gynecol. 2011 Mar;117(3):650-656. doi: 10.1097/AOG.0b013e318209da59.
To explore the effect of screening history on the risk of cervical precancer and cancer after an human papillomavirus (HPV)-positive test.
A large health maintenance organization introduced cytology and HPV cotesting into routine clinical practice in 2003. We selected women aged 30 and older who tested HPV positive, cytology negative between January 2006 and December 2008 who had any clinical follow-up documented before January 2010 (n=26,799). The 1-year and 4-year cumulative incidence rates and rate ratios for cervical intraepithelial neoplasia grade 2 or higher (CIN 2+) with 95% confidence intervals (95% CIs) were calculated as estimates of absolute risk and relative risk, respectively. Results were stratified on immediate past HPV test and Pap results.
Without consideration of past screening round, the 1-year and 4-year cumulative incidence rates for CIN 2+ after an HPV-positive, Pap-negative result were 2.83 (95% CI 2.55-3.12) and 7.89 (95% CI 7.00-8.78). However, risks varied substantially by past screening result. For example, the 4-year risk of CIN2+ was greater for women who had a past HPV-positive, Pap-negative result (cumulative incidence rate=11.79, 95% CI 10.22-13.36) compared with those who had HPV-negative, Pap-negative result (cumulative incidence rate=4.56, 95% CI 3.43-5.69; cumulative incidence rate ratio=2.59, 95% CI 2.30-2.87).
Because cervical precancer is associated with persistent HPV infection, the risk associated with an HPV-positive test can vary significantly depending on the immediate past screening round. Optimizing screening programs will require knowledge of screening history.
探讨 HPV 阳性检测后筛查史对宫颈癌前病变和癌症风险的影响。
一家大型健康维护组织于 2003 年将细胞学和 HPV 联合检测纳入常规临床实践。我们选择了 2006 年 1 月至 2008 年 12 月间 HPV 阳性、细胞学阴性且在 2010 年 1 月前有任何临床随访记录的年龄在 30 岁及以上的女性（n=26799）。计算了 1 年和 4 年的累积发生率以及 CIN2+的相对风险比（95%置信区间[95%CI]），以分别估计绝对风险和相对风险。结果按最近一次 HPV 检测和巴氏涂片结果分层。
不考虑过去的筛查轮次，HPV 阳性、巴氏涂片阴性结果后 CIN2+的 1 年和 4 年累积发生率分别为 2.83（95%CI 2.55-3.12）和 7.89（95%CI 7.00-8.78）。然而，风险随过去的筛查结果而显著变化。例如，过去 HPV 阳性、巴氏涂片阴性结果的女性的 4 年 CIN2+风险大于 HPV 阴性、巴氏涂片阴性结果的女性（累积发生率=11.79，95%CI 10.22-13.36 与累积发生率=4.56，95%CI 3.43-5.69；累积发生率比=2.59，95%CI 2.30-2.87）。
由于宫颈癌前病变与持续性 HPV 感染有关，因此 HPV 阳性检测的风险可能会因最近一次的筛查轮次而显著不同。优化筛查方案需要了解筛查史。
