Zentrum für Frauenheilkunde, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Street 1, 30625 Hannover, Germany.
BMC Cancer. 2013 Aug 9;13:379. doi: 10.1186/1471-2407-13-379.
Primary human papilloma virus (HPV) screening is more effective than cytology in reducing the risk of cervical cancer, but screening intervals should be extended in HPV-negative women. However, some Markov models predicted that long intervals are associated with an excess risk of cervical cancer. The aim of this analysis was to estimate the real-life risks and benefits of annual Papanicolaou (Pap) screening in HPV-negative women with normal cytology.
Women with negative Hybrid Capture 2 (HC2) results and normal cytology at the time of inclusion in the Hannover HPV screening trial underwent annual Pap smears for 5 years. A subgroup was randomly selected for retesting with cytology, HC2, and colposcopy 60-68 months after recruitment.
Of 4236 women included, 3406 had at least one Pap smear, but only 1185 attended all five annual screening visits. The proportion of women with at least one abnormal smear was 14.4% in 60 months. The probability of abnormal smears increased continuously over time. No case of ≥ CIN2+ was observed during 5 years. Of 605 women selected for subgroup analysis, 292 agreed to be retested (48.3%). The rate of high-risk HPV at 60-68 months was 3.0% (9/296).
The long-term risk of high-grade neoplasia after an initial negative HC2 test and normal cytology result was low, while the rate of false-positive abnormal Pap smears was significant and increased constantly over time. Pap smear screening of HPV-negative women more frequently than every 5 years could be potentially harmful and seems to be of little clinical value.
与细胞学相比，原发性人乳头瘤病毒（HPV）筛查在降低宫颈癌风险方面更为有效，但 HPV 阴性女性的筛查间隔应延长。然而，一些马尔可夫模型预测，较长的间隔与宫颈癌风险增加有关。本分析的目的是估计在 HPV 阴性且细胞学正常的女性中，每年进行巴氏涂片检查的实际风险和获益。
在汉诺威 HPV 筛查试验中，纳入时 Hybrid Capture 2（HC2）结果为阴性且细胞学正常的女性，每 5 年进行一次巴氏涂片检查。在招募后 60-68 个月，随机选择一个亚组进行细胞学、HC2 和阴道镜检查的复查。
在纳入的 4236 名女性中，3406 人至少进行了一次巴氏涂片检查，但只有 1185 人参加了所有五次年度筛查访问。在 60 个月时，至少有一次异常涂片的女性比例为 14.4%。异常涂片的概率随时间持续增加。在 5 年内未观察到≥CIN2+病例。在 605 名被选中进行亚组分析的女性中，有 292 人同意接受复查（48.3%）。在 60-68 个月时，高危型 HPV 的检出率为 3.0%（9/296）。
在初始 HC2 检测和正常细胞学结果阴性后，高级别肿瘤的长期风险较低，而巴氏涂片检查假阳性异常的发生率较高，且随时间持续增加。与每 5 年一次相比，更频繁地对 HPV 阴性女性进行巴氏涂片检查可能是有害的，并且似乎没有多少临床价值。
