Pankakoski Maiju, Heinävaara Sirpa, Sarkeala Tytti, Anttila Ahti
1 Finnish Cancer Registry, Helsinki, Finland.
2 Faculty of Medicine, University of Helsinki, Finland.
J Med Screen. 2017 Dec;24(4):201-207. doi: 10.1177/0969141316685740. Epub 2017 Jan 10.
Objective Regular screening and follow-up is an important key to cervical cancer prevention; however, screening inevitably detects mild or borderline abnormalities that would never progress to a more severe stage. We analysed the cumulative probability and recurrence of cervical abnormalities in the Finnish organized screening programme during a 22-year follow-up. Methods Screening histories were collected for 364,487 women born between 1950 and 1965. Data consisted of 1 207,017 routine screens and 88,143 follow-up screens between 1991 and 2012. Probabilities of cervical abnormalities by age were estimated using logistic regression and generalized estimating equations methodology. Results The probability of experiencing any abnormality at least once at ages 30-64 was 34.0% (95% confidence interval [CI]: 33.3-34.6%) . Probability was 5.4% (95% CI: 5.0-5.8%) for results warranting referral and 2.2% (95% CI: 2.0-2.4%) for results with histologically confirmed findings. Previous occurrences were associated with an increased risk of detecting new ones, specifically in older women. Conclusion A considerable proportion of women experience at least one abnormal screening result during their lifetime, and yet very few eventually develop an actual precancerous lesion. Re-evaluation of diagnostic criteria concerning mild abnormalities might improve the balance of harms and benefits of screening. Special monitoring of women with recurrent abnormalities especially at older ages may also be needed.
目的 定期筛查和随访是预防宫颈癌的重要关键；然而，筛查不可避免地会检测到一些轻度或临界异常，而这些异常永远不会进展到更严重的阶段。我们分析了芬兰有组织筛查计划中22年随访期间宫颈异常的累积概率和复发情况。方法 收集了1950年至1965年出生的364487名女性的筛查史。数据包括1991年至2012年期间的1207017次常规筛查和88143次随访筛查。使用逻辑回归和广义估计方程方法估计不同年龄宫颈异常的概率。结果 30至64岁女性至少有一次出现任何异常的概率为34.0%（95%置信区间[CI]：33.3 - 34.6%）。需要转诊结果的概率为5.4%（95%CI：5.0 - 5.8%），组织学确诊结果的概率为2.2%（95%CI：2.0 - 2.4%）。既往出现异常与检测到新异常的风险增加相关，尤其是在老年女性中。结论 相当一部分女性在一生中至少有一次筛查结果异常，但最终很少有人会发展为实际的癌前病变。重新评估关于轻度异常的诊断标准可能会改善筛查的利弊平衡。对于反复出现异常的女性，尤其是老年女性，可能也需要进行特殊监测。
