Martingano Daniel, Renson Audrey, Martingano Alison Jane, Martingano Francis X
J Am Osteopath Assoc. 2018 Jan 1;118(1):8-18. doi: 10.7556/jaoa.2018.003.
Although not incorporated into current cervical cancer screening guidelines, racial differences are known to persist in both occurrence of and outcomes related to cervical cancer.
To compare the differences in progression and regression of precancerous lesions of the uterine cervix on cervical cytologic analysis among women of different races who adhered to cervical cancer screening recommendations and follow-up.
Retrospective cohort study comparing differences in precancerous lesion diagnoses for patients receiving adequate evaluation according to the American Society for Colposcopy and Cervical Pathology guidelines. The authors fit Markov multistate models to estimate self-reported race-specific expected wait times and hazard ratios for each possible regression and progression and compared a race model with an intercept-only model using a likelihood ratio test.
The sample included 5472 women receiving a Papanicolaou test between January 2006 and September 2016, contributing a total of 24,316 person-years of follow-up. Of 21 hazard ratios tested for significance, the following 4 hazard ratios (95% CIs) were statistically significant: atypical squamous cells of undetermined significance (ASC-US) progression to low-grade squamous intraepithelial lesion (LSIL) for Hispanic patients (0.72; 95% CI, 0.54-0.96); LSIL regression to ASC-US for Hispanic patients (1.55; 95% CI, 1.04-2.31), LSIL regression to ASC-US for Asian patients (1.91; 95% CI, 1.08-3.36), and high-grade squamous intraepithelial lesion regression to LSIL for black patients (0.39; 95% CI, 0.16-0.96). There is an observed trend that all racial groups other than white had a slower rate of progression from ASC-US to LSIL, with Hispanics having demonstrated the slowest rate from ASC-US to LSIL. Hispanics also demonstrated the fastest rate from LSIL to HSIL when compared with all other race categories. In regressions, blacks had the slowest rate of regression from HSIL to LSIL, and Asians had the fastest rate from LSIL to ASC-US. The Hispanic group demonstrated the fastest expected progression (17.6 months; 95% CI, 11.5-25.5), as well as the fastest regression (27.6 months; 95% CI, 21.5-35.6), and the black group has the slowest expected times for both progression (28.1 months; 95% CI, 14.6-47.2) and regression (49 months; 95% CI, 29.1-86.2). The number of visits (1 vs ≥2) in the study was differentially distributed both by race (P=.033) and by last diagnosis (P<.001).
Variations in precancerous lesions of the uterine cervix are not uniform across races.
尽管种族差异未纳入当前宫颈癌筛查指南，但已知在宫颈癌的发生及相关结局方面持续存在种族差异。
比较遵循宫颈癌筛查建议并接受随访的不同种族女性宫颈细胞学分析中子宫颈癌前病变进展和消退的差异。
回顾性队列研究，比较根据美国阴道镜和宫颈病理学会指南接受充分评估的患者癌前病变诊断的差异。作者采用马尔可夫多状态模型来估计自我报告的种族特异性预期等待时间以及每种可能的消退和进展的风险比，并使用似然比检验将种族模型与仅含截距的模型进行比较。
样本包括2006年1月至2016年9月期间接受巴氏试验的5472名女性，总共提供了24316人年的随访数据。在测试的21个风险比中，以下4个风险比（95%可信区间）具有统计学意义：西班牙裔患者意义不明确的非典型鳞状细胞（ASC-US）进展为低级别鳞状上皮内病变（LSIL）（0.72；95%可信区间，0.54 - 0.96）；西班牙裔患者LSIL消退为ASC-US（1.55；95%可信区间，1.04 - 2.31），亚洲患者LSIL消退为ASC-US（1.91；95%可信区间，1.08 - 3.36），以及黑人患者高级别鳞状上皮内病变消退为LSIL（0.39；95%可信区间，0.16 - 0.96）。观察到一种趋势，即除白人外的所有种族群体从ASC-US进展到LSIL的速度较慢，其中西班牙裔从ASC-US进展到LSIL的速度最慢。与所有其他种族类别相比，西班牙裔从LSIL进展到HSIL的速度也最快。在消退方面，黑人从HSIL消退到LSIL的速度最慢，而亚洲人从LSIL消退到ASC-US的速度最快。西班牙裔群体显示出最快的预期进展（17.6个月；95%可信区间，11.5 - 25.5），以及最快的消退（27.6个月；95%可信区间，21.5 - 35.6），而黑人组在进展（28.1个月；95%可信区间，14.6 - 47.2）和消退（49个月；95%可信区间，29.1 - 86.2）方面的预期时间最慢。研究中的就诊次数（1次与≥2次）在种族（P = 0.033）和末次诊断（P < 0.001）方面分布存在差异。
子宫颈癌前病变在不同种族间存在差异，并非均匀一致。
