Cuzick Jack, Myers Orrin, Hunt William C, Saslow Debbie, Castle Philip E, Kinney Walter, Waxman Alan, Robertson Michael, Wheeler Cosette M
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
Int J Cancer. 2015 Jun 15;136(12):2854-63. doi: 10.1002/ijc.29337. Epub 2014 Dec 1.
In the United States, high-risk human papillomavirus (HPV) testing is recommended for women with atypical squamous cells of unknown significance (ASC-US) cytology, and co-testing with cytology and HPV is a recommended option for screening women aged ≥ 30 years. No population-based data are available to examine utilization of HPV testing in the United States. Using the New Mexico HPV Pap Registry data resource, we describe population trends (2007-2012) in utilization and positivity rates for HPV testing as a routine co-testing screening procedure and for triage of ASC-US and other cytologic outcomes. For women aged 30-65 years co-testing increased from 5.2% in 2007 to 19.1% in 2012 (p < 0.001). Overall 82% of women with ASC-US cytology who did not receive co-testing also had an HPV test. HPV positivity was age and cytology result dependent but did not show time trends. For women with negative cytology, 64% received an additional screening test within 3 years if no co-test was done or if it was positive, but this was reduced to 47% with a negative co-test. Reflex HPV testing for ASC-US cytology is well established and occurs in most women. Evidence for reflex testing is also observed following other abnormal cytology outcomes. Co-testing in women aged 30-65 years has more than tripled from 2007 to 2012, but was still only used in 19.1% of women aged 30-65 years attending for screening in 2012. Women receiving co-testing had longer repeat screening intervals, but rescreening within 3 years is still very common even with co-testing.
在美国，对于非典型鳞状细胞意义不明确（ASC-US）的女性，建议进行高危型人乳头瘤病毒（HPV）检测，对于30岁及以上女性，推荐采用HPV检测与细胞学联合检测作为筛查方法。目前尚无美国HPV检测使用情况的基于人群的数据。利用新墨西哥州HPV巴氏涂片登记数据资源，我们描述了HPV检测作为常规联合检测筛查程序以及用于ASC-US和其他细胞学结果分流的使用情况和阳性率的人群趋势（2007 - 2012年）。对于30 - 65岁的女性，联合检测从2007年的5.2%增至2012年的19.1%（p < 0.001）。总体而言，未接受联合检测的ASC-US细胞学女性中，82%也进行了HPV检测。HPV阳性率取决于年龄和细胞学结果，但未显示出时间趋势。对于细胞学阴性的女性，如果未进行联合检测或联合检测结果为阳性，64%在3年内接受了额外筛查检测，但联合检测结果为阴性时，这一比例降至47%。针对ASC-US细胞学的反射性HPV检测已广泛应用于大多数女性。在其他异常细胞学结果后也观察到了反射性检测的证据。2007年至2012年，30 - 65岁女性联合检测的使用率增长了两倍多，但2012年在接受筛查的30 - 65岁女性中仍仅占19.1%。接受联合检测的女性重复筛查间隔更长，但即使进行了联合检测，3年内再次筛查仍然非常普遍。
