Holt Hunter K, Kulasingam Shalini, Sanstead Erinn C, Alarid-Escudero Fernando, Smith-McCune Karen, Gregorich Steven E, Silverberg Michael J, Huchko Megan J, Kuppermann Miriam, Sawaya George F
Department of Family and Community Medicine, University of California, San Francisco, California.
Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
MDM Policy Pract. 2020 Aug 19;5(2):2381468320952409. doi: 10.1177/2381468320952409. eCollection 2020 Jul-Dec.
In 2018, the US Preventive Services Task Force (USPSTF) endorsed three strategies for cervical cancer screening in women ages 30 to 65: cytology every 3 years, testing for high-risk types of human papillomavirus (hrHPV) every 5 years, and cytology plus hrHPV testing (co-testing) every 5 years. It further recommended that women discuss with health care providers which testing strategy is best for them. To inform such discussions, we used decision analysis to estimate outcomes of screening strategies recommended for women at age 30. We constructed a Markov decision model using estimates of the natural history of HPV and cervical neoplasia. We evaluated the three USPSTF-endorsed strategies, hrHPV testing every 3 years and no screening. Outcomes included colposcopies with biopsy, false-positive testing (a colposcopy in which no cervical intraepithelial neoplasia grade 2 or worse was found), treatments, cancers, and cancer mortality expressed per 10,000 women over a shorter-than-lifetime horizon (15-year). All strategies resulted in substantially lower cancer and cancer death rates compared with no screening. Strategies with the lowest likelihood of cancer and cancer death generally had higher likelihood of colposcopy and false-positive testing. The screening strategies we evaluated involved tradeoffs in terms of benefits and harms. Because individual women may place different weights on these projected outcomes, the optimal choice for each woman may best be discerned through shared decision making.
2018年，美国预防服务工作组（USPSTF）认可了针对30至65岁女性宫颈癌筛查的三种策略：每3年进行一次细胞学检查、每5年检测一次高危型人乳头瘤病毒（hrHPV）以及每5年进行一次细胞学检查加hrHPV检测（联合检测）。该工作组还进一步建议女性与医疗服务提供者讨论哪种检测策略最适合自己。为了为这类讨论提供信息，我们运用决策分析来估算针对30岁女性推荐的筛查策略的结果。我们利用HPV和宫颈肿瘤形成的自然史估计值构建了一个马尔可夫决策模型。我们评估了USPSTF认可的三种策略、每3年进行一次hrHPV检测以及不进行筛查。结果包括每10,000名女性在短于一生的时间范围（15年）内进行活检的阴道镜检查、假阳性检测（未发现宫颈上皮内瘤变2级或更高级别病变的阴道镜检查）、治疗、癌症以及癌症死亡率。与不进行筛查相比，所有策略导致的癌症和癌症死亡率均大幅降低。癌症和癌症死亡可能性最低的策略通常阴道镜检查和假阳性检测的可能性较高。我们评估的筛查策略在益处和危害方面存在权衡。由于个体女性可能对这些预期结果赋予不同的权重，通过共同决策或许能最好地为每位女性确定最佳选择。
