Kaiser Permanente Washington Health Research Institute, Seattle, WA.
Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX.
Int J Cancer. 2019 Mar 15;144(6):1460-1473. doi: 10.1002/ijc.31940. Epub 2018 Dec 20.
Little is known about the effect of evolving risk-based cervical cancer screening and management guidelines on United States (US) clinical practice and patient outcomes. We describe the National Cancer Institute's Population-based Research Optimizing Screening through Personalized Regimens (PROSPR I) consortium, methods and baseline findings from its cervical sites: Kaiser Permanente Washington, Kaiser Permanente Northern California, Kaiser Permanente Southern California, Parkland Health & Hospital System/University of Texas Southwestern (Parkland-UTSW) and New Mexico HPV Pap Registry housed by University of New Mexico (UNM-NMHPVPR). Across these diverse healthcare settings, we collected data on human papillomavirus (HPV) vaccinations, screening tests/results, diagnostic and treatment procedures/results and cancer diagnoses on nearly 4.7 million women aged 18-89 years from 2010 to 2014. We calculated baseline (2012 for UNM-NMHPVPR; 2010 for other sites) frequencies for sociodemographics, cervical cancer risk factors and key screening process measures for each site's cohort. Healthcare delivery settings, cervical cancer screening strategy, race/ethnicity and insurance status varied among sites. The proportion of women receiving a Pap test during the baseline year was similar across sites (26.1-36.1%). Most high-risk HPV tests were performed either reflexively or as cotests, and utilization pattern varied by site. Prevalence of colposcopy or biopsy was higher at Parkland-UTSW (3.6%) than other sites (1.3-1.4%). Incident cervical cancer was rare. HPV vaccination among age-eligible women not already immunized was modest across sites (0.1-7.2%). Cervical PROSPR I makes available high-quality, multilevel, longitudinal screening process data from a large and diverse cohort of women to evaluate and improve the effectiveness of US cervical cancer screening delivery.
关于不断发展的基于风险的宫颈癌筛查和管理指南对美国(美国)临床实践和患者结局的影响知之甚少。我们描述了美国国家癌症研究所的基于人群的研究通过个性化治疗方案优化筛查(PROSPR I)联盟,及其宫颈癌部位的方法和基线结果:凯撒永久华盛顿、凯撒永久北加州、凯撒永久南加州、帕克兰健康与医院系统/德克萨斯西南大学(帕克兰-德克萨斯西南大学)和新墨西哥 HPV 巴氏涂片登记处由新墨西哥大学(UNM-NMHPVPR)管理。在这些不同的医疗保健环境中,我们收集了近 470 万名 18-89 岁女性的人乳头瘤病毒(HPV)疫苗接种、筛查试验/结果、诊断和治疗程序/结果以及癌症诊断数据,时间范围为 2010 年至 2014 年。我们计算了每个地点队列的社会人口统计学、宫颈癌危险因素和关键筛查过程措施的基线(2012 年用于 UNM-NMHPVPR;其他地点为 2010 年)频率。医疗保健提供环境、宫颈癌筛查策略、种族/民族和保险状况在各地点之间存在差异。在基线年接受巴氏涂片检查的女性比例在各地点相似(26.1%-36.1%)。大多数高危 HPV 检测要么是反射性的,要么是联合检测,而且使用模式因地点而异。在 Parkland-UTSW(3.6%),阴道镜检查或活检的比例高于其他地点(1.3%-1.4%)。宫颈癌的发病率很低。在符合年龄条件但尚未免疫的女性中,HPV 疫苗接种率在各地点之间差异不大(0.1%-7.2%)。宫颈 PROSPR I 为评估和改善美国宫颈癌筛查提供了来自大量和多样化女性队列的高质量、多层次、纵向筛查过程数据。
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