Castanon Alejandra, Landy Rebecca, Sasieni Peter
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK.
J Med Screen. 2017 Jun;24(2):110-112. doi: 10.1177/0969141316654197. Epub 2016 Jun 30.
Objective The replacement of cytology with human papillomavirus testing as the primary cervical screening test in England is imminent. In light of newly available evidence, we revised our previous estimates of the likely impact of primary human papillomavirus testing on incidence of cervical cancer. Method and results Using screening data on women aged 25-64 diagnosed with cervical cancer in England between 1988 and 2012, we previously reported that 38.8% had a negative test six months to six years prior to diagnosis. However, not all of these cancers would be prevented by human papillomavirus testing: for 1.0% the human papillomavirus positive test would come too late (within 18 months of diagnosis) to make a difference; 7.6% will have a negative human papillomavirus test (based on 79.9% sensitivity of human papillomavirus testing in cytology negative women); and 2.0% will develop cancer despite a positive human papillomavirus test. Additionally, we estimate that some women (equivalent to 4.3% of current incidence) whose cancers are currently prevented by cytology-based screening will have a false-negative human papillomavirus test. Conclusion Overall, we estimate that 23.9% (95% CI: 19.3-27.6%) of current cases in women invited for screening could be prevented. Based on 2013 cancer incidence statistics, absolute numbers could be reduced by 487 (95% CI 394 to 563) or 3.4 (95% CI 2.8 to 4.0) per 100,000 women per year.
目的 在英国，用人类乳头瘤病毒检测取代细胞学检查作为主要的宫颈癌筛查检测即将实现。鉴于新获得的证据，我们修订了之前对原发性人类乳头瘤病毒检测对宫颈癌发病率可能影响的估计。方法与结果 利用1988年至2012年间在英国诊断为宫颈癌的25至64岁女性的筛查数据，我们之前报告称，38.8%的患者在诊断前6个月至6年检测结果为阴性。然而，并非所有这些癌症都能通过人类乳头瘤病毒检测预防：1.0%的患者人类乳头瘤病毒检测呈阳性时已为时过晚（在诊断后18个月内），无法产生影响；7.6%的患者人类乳头瘤病毒检测结果为阴性（基于人类乳头瘤病毒检测在细胞学检查阴性女性中的敏感性为79.9%）；2.0%的患者尽管人类乳头瘤病毒检测呈阳性仍会患癌。此外，我们估计，目前通过基于细胞学的筛查预防患癌的一些女性（相当于当前发病率的4.3%），其人类乳头瘤病毒检测会出现假阴性。结论 总体而言，我们估计，受邀参加筛查的女性中，目前23.9%（95%置信区间：19.3 - 27.6%）的病例可以预防。根据统计，每年每10万名女性中，绝对病例数可减少487例（95%置信区间394至563）或3.4例（95%置信区间2.8至4.0）。
