(Current affiliation) Lowy Cancer Research Centre, Prince of Wales Clinical School, The University of NSW, Sydney, Australia.
BMC Public Health. 2013 Dec 18;13:1196. doi: 10.1186/1471-2458-13-1196.
Cervical screening is currently recommended every two years in sexually active women aged 18-20 to 69 years in Australia. Direct replacement of conventional cytology with liquid-based cytology (LBC) for cervical screening was rejected for public funding on grounds of cost-effectiveness, first in 2002 and again in 2009, but LBC is performed as an adjunct to conventional cytology in women who elect to pay. The objective of this study was to describe prevalence and predictors of use of LBC in Australia's most populous state, New South Wales (NSW).
We performed cross-sectional and population-based cohort analyses using data from the state Pap Test Register in NSW. We calculated the age-adjusted proportion of women aged 20-69 years electing to have adjunctive LBC over the period from 2006-2010. We also calculated the fully-adjusted odds ratios for the association between subsequent LBC use and age, socioeconomic status, place of residence, previous cytological history and provider type in a cohort of 360,247 women who had an index cervical cytology test in 2006-8.
Uptake of LBC varied between 29.7% (95% Confidence Interval (CI): 29.5-30.0%) in 2006/7 and 26.6% (95% CI: 26.4-26.9%) in 2009/10. LBC was more likely to be used in women aged 30-44 years, if it had been used previously (OR13.58, 95% CI: 13.33-13.84), if the previous test result was abnormal (OR2.62, 95% CI:2.53-2.72) or unsatisfactory (OR2.37, 95% CI:2.27-3.47), or if a gynaecologist requested the test (OR1.50, 95% CI:1.46-1.54). Uptake was least for women in remote/very remote areas (OR0.68; 95% CI:0.57-0.80 referenced to those in major cities) and in lower socioeconomic groups (OR 0.41, 95% CI:0.40-0.42 for lowest versus highest SES quintile).
In the current environment in NSW, Australia, in which public funding for LBC has not been available, adjunctive uptake of LBC depends strongly on a woman's age, her screening history and socioeconomic factors. These findings provide important context for a current review of technologies used in the National Cervical Screening Program in Australia.
在澳大利亚，目前建议性活跃的 18-20 岁至 69 岁女性每两年进行一次宫颈筛查。2002 年和 2009 年，由于成本效益原因，曾否决过用液基细胞学（LBC）直接替代传统细胞学用于宫颈筛查，但在选择付费的女性中，LBC 被用作传统细胞学的辅助手段。本研究的目的是描述澳大利亚人口最多的新南威尔士州（NSW）使用 LBC 的流行率和预测因素。
我们使用新南威尔士州巴氏试验登记处的数据进行了横断面和基于人群的队列分析。我们计算了 2006-2010 年间 20-69 岁女性选择辅助性 LBC 的年龄调整比例。我们还计算了在 2006-8 年间进行了索引宫颈细胞学检查的 360247 名女性队列中，随后使用 LBC 的完全调整比值比，与年龄、社会经济地位、居住地、以前的细胞学史和提供者类型之间的关联。
LBC 的使用率在 2006/7 年为 29.7%（95%置信区间（CI）：29.5-30.0%）和 2009/10 年为 26.6%（95% CI：26.4-26.9%）之间存在差异。如果之前使用过 LBC（OR13.58，95% CI：13.33-13.84）、如果之前的检测结果异常（OR2.62，95% CI：2.53-2.72）或不满意（OR2.37，95% CI：2.27-3.47），或妇科医生要求进行检查（OR1.50，95% CI：1.46-1.54），则 LBC 的使用更有可能。对于偏远/非常偏远地区的女性（OR0.68；95% CI：0.57-0.80，参考大城市地区）和社会经济地位较低的女性（OR 0.41，95% CI：0.40-0.42，最低与最高 SES 五分位数），使用率最低。
在当前澳大利亚新南威尔士州，LBC 没有公共资金支持的情况下，辅助性 LBC 的使用率强烈依赖于女性的年龄、筛查史和社会经济因素。这些发现为澳大利亚国家宫颈筛查计划中使用的技术的当前审查提供了重要背景。
