Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent, Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
Department of Community Health, Tufts University, Boston, Massachusetts; Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts; The Fenway Institute, Fenway Health, Boston, Massachusetts.
Womens Health Issues. 2020 Jul-Aug;30(4):306-312. doi: 10.1016/j.whi.2020.02.002. Epub 2020 Apr 2.
Although much has been published in recent years on differences in Papanicolaou (Pap) tests across sexual orientation, other aspects of cervical cancer prevention remain underexplored, such as human papillomavirus (HPV) vaccination, HPV co-tests, or abnormal Pap tests.
Data came from participants (aged 24-54 years) enrolled in an ongoing, longitudinal, U.S.-based cohort study, the Nurses' Health Study 3 (N = 12,175). Analyses were restricted to participants who met the current guidelines for care (e.g., ≥21 years of age for Pap tests).
Mostly heterosexual women were more likely to initiate HPV vaccination than completely heterosexual women with no same-sex partners. All other comparisons across sexual orientation for HPV vaccination initiation and completion and the age of initiation were not statistically significant. Compared with completely heterosexual women with no same-sex partners, mostly heterosexual and lesbian women had lower odds of having a Pap test within the past 2 years. Completely heterosexual women with same-sex partners, mostly heterosexual women, and bisexual women had their first Pap test at an earlier age, had higher odds of having an HPV co-test, and had higher odds of having a positive HPV or abnormal Pap test compared with completely heterosexual women with no same-sex partners. In contrast, lesbian women had lower odds of having positive HPV or abnormal Pap results (odds ratio, 0.65; 95% confidence interval, 0.49-0.86) than completely heterosexual women with no same-sex partners.
There are significant differences across sexual orientation groups in cervical cancer prevention for Pap test timing and positive HPV and abnormal Pap tests, but few differences in HPV vaccination initiation, completion, and age at initiation. Interventions should focus on increasing routine Pap testing among mostly heterosexual and lesbian women.
尽管近年来有大量关于性取向对巴氏涂片（Pap）检测差异的研究发表，但其他方面的宫颈癌预防仍未得到充分探索，例如人乳头瘤病毒（HPV）疫苗接种、HPV 联合检测或异常巴氏涂片检测。
数据来自正在进行的、基于美国的纵向队列研究——护士健康研究 3（N=12175）中的参与者（年龄 24-54 岁）。分析仅限于符合当前护理指南的参与者（例如，巴氏涂片检查的年龄≥21 岁）。
与没有同性伴侣的完全异性恋女性相比，多数异性恋女性更有可能开始接种 HPV 疫苗。在 HPV 疫苗接种开始和完成以及开始接种年龄方面，所有其他性取向的比较均无统计学意义。与没有同性伴侣的完全异性恋女性相比，多数异性恋和女同性恋者进行巴氏涂片检查的频率较低。有同性伴侣的完全异性恋女性、多数异性恋女性和双性恋女性进行首次巴氏涂片检查的年龄较早，进行 HPV 联合检测的几率更高，HPV 阳性或异常巴氏涂片检测的几率更高，而没有同性伴侣的完全异性恋女性进行巴氏涂片检查的几率更高。相比之下，与没有同性伴侣的完全异性恋女性相比，女同性恋者 HPV 阳性或异常巴氏涂片检测结果的几率较低（比值比，0.65；95%置信区间，0.49-0.86）。
在巴氏涂片检查时间以及 HPV 阳性和异常巴氏涂片检测结果方面，不同性取向群体之间存在显著差异，但 HPV 疫苗接种开始、完成以及开始接种年龄方面的差异较小。干预措施应侧重于增加多数异性恋和女同性恋者的常规巴氏涂片检查。
