Watson Meg, Benard Vicki, Lin Lavinia, Rockwell Tanner, Royalty Janet
Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE MS-F76, Atlanta, GA, 30341, USA,
Cancer Causes Control. 2015 May;26(5):759-64. doi: 10.1007/s10552-015-0549-9. Epub 2015 Mar 21.
Reflex human papillomavirus (HPV) testing is the preferred triage option for most women diagnosed with atypical squamous cells of undetermined significance (ASC-US). This study was conducted to describe follow-up results of women with ASC-US Pap test results in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), focusing on HPV test use.
We examined the follow-up of 45,049 women in the NBCCEDP with ASC-US Pap tests during 2009-2011. Data on demographic characteristics, diagnostic procedures, and clinical outcomes were analyzed.
NBCCEDP providers diagnosed 45,049 women (4.5 % of all Pap tests) with an ASC-US result. Of those, 28,271 (62.8 %) were followed with an HPV test, 3,883 (8.6 %) with a repeat Pap test, 6,592 (14.6 %) with colposcopy, and 6,303 were lost to follow-up (14.0 %). Women aged 40 and older were followed more often with an HPV test. White, black, and Asian/Pacific Islander women were followed more often with an HPV test after an ASC-US Pap compared to Hispanic and American Indian/Alaska Native (AI/AN) women. Among women with a positive HPV test on follow-up, almost 90 % continued with colposcopy as recommended. AI/AN women had the highest rates of HPV positivity (55.2 %) and of no follow-up (25.0 %).
This is the first analysis describing follow-up of ASC-US Pap test results in the NBCCEDP, providing a window into current management of ASC-US results. Findings raise concerns about persistent disparities among AI/AN women. During 2009-2011, nearly two-thirds of women with an ASC-US Pap test result were followed with an HPV reflex test.
对于大多数被诊断为意义不明确的非典型鳞状细胞（ASC-US）的女性，人乳头瘤病毒（HPV）反射检测是首选的分流选项。本研究旨在描述国家乳腺癌和宫颈癌早期检测项目（NBCCEDP）中ASC-US巴氏试验结果女性的随访结果，重点关注HPV检测的使用情况。
我们检查了2009年至2011年期间NBCCEDP中45049例进行ASC-US巴氏试验的女性的随访情况。分析了人口统计学特征、诊断程序和临床结果的数据。
NBCCEDP的提供者诊断出45049名女性（占所有巴氏试验的4.5%）有ASC-US结果。其中，28271名（62.8%）接受了HPV检测随访，3883名（8.6%）接受了重复巴氏试验随访，6592名（14.6%）接受了阴道镜检查随访，6303名失访（14.0%）。40岁及以上的女性更常接受HPV检测随访。与西班牙裔和美国印第安人/阿拉斯加原住民（AI/AN）女性相比，白人、黑人和亚太岛民女性在ASC-US巴氏试验后更常接受HPV检测随访。在随访中HPV检测呈阳性的女性中，近90%按照建议继续接受阴道镜检查。AI/AN女性的HPV阳性率（55.2%）和无随访率（25.0%）最高。
这是首次对NBCCEDP中ASC-US巴氏试验结果的随访情况进行分析，为目前ASC-US结果的管理提供了一个窗口。研究结果引发了对AI/AN女性持续存在差异的担忧。在2009年至2011年期间，近三分之二ASC-US巴氏试验结果的女性接受了HPV反射检测随访。
