Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Womens Health (Larchmt). 2021 Jun;30(6):902-909. doi: 10.1089/jwh.2020.8381. Epub 2020 Sep 22.
Although minority women are at higher risk of cervical cancer in the United States, little is known about differences in rates of colposcopy and loop electrosurgical excision procedure (LEEP) by race once patients present for care. A prospective registry of patients presenting to an academic colposcopy clinic was queried from 2008 to 2018. Women with missing race or cytology results, prior hysterectomy, or prior history of cervical, vulvar, or vaginal cancer were excluded. Poisson and logistic regression models were performed to evaluate the associations between race and colposcopy, LEEP, and cancer rates, adjusting for referral Papanicolaou (Pap), human papillomavirus (HPV) result, year of visit, age, insurance, pregnancy, number of sexual partners, and smoking status. A total of 4506 women were included (56.1% white and 43.9% non-white). Referral for high-grade cytology was more likely among white compared to non-white women (22.5% vs. 17.5%, < 0.001), as well as positive HPV testing (white 7.8% vs. non-white 6.0%, < 0.001). The colposcopy rate was slightly higher among black (incidence rate ratio [IRR] 1.11, 95% confidence interval [CI] 1.03-1.19, = 0.006) and Hispanic women (IRR 1.13, 95% CI 1.06-1.21, = 0.0003) compared to white women. Hispanic women were significantly more likely to undergo LEEP (odds ratio 1.26, 95% CI 1.01-1.58, = 0.04). However, no significant difference in cancer, adenocarcinoma , or high-grade histology was noted by race. Black and Hispanic women referred for abnormal Pap or HPV results underwent a greater number of colposcopies compared to white women, and Hispanic women underwent a greater number of LEEPs. Although cancer is rare in our cohort, there was no statistical difference in rate of cancer by race.
尽管在美国少数民族女性患宫颈癌的风险较高，但对于患者就诊后阴道镜检查和环形电切术 (LEEP) 的种族差异知之甚少。对 2008 年至 2018 年期间到学术阴道镜检查诊所就诊的患者进行了前瞻性登记。排除了种族或细胞学检查结果缺失、子宫切除史、宫颈癌、外阴癌或阴道癌病史的患者。采用泊松和逻辑回归模型评估种族与阴道镜检查、LEEP 和癌症发生率之间的关系，调整转诊巴氏涂片 (Pap)、人乳头瘤病毒 (HPV) 结果、就诊年份、年龄、保险、怀孕、性伴侣数量和吸烟状况。共纳入 4506 名女性（56.1%为白人，43.9%为非白人）。与非白人女性相比，白人女性更有可能因高级别细胞学检查而转诊（22.5%比 17.5%，<0.001），HPV 检测阳性的可能性也更高（白人 7.8%比非白人 6.0%，<0.001）。黑人（比值比 [IRR] 1.11，95%置信区间 [CI] 1.03-1.19，=0.006）和西班牙裔女性（IRR 1.13，95% CI 1.06-1.21，=0.0003）的阴道镜检查率略高白人女性。与白人女性相比，西班牙裔女性更有可能接受 LEEP（优势比 1.26，95% CI 1.01-1.58，=0.04）。然而，种族之间的癌症、腺癌或高级别组织学并无显著差异。黑人女性和西班牙裔女性因 Pap 或 HPV 结果异常而转诊的患者比白人女性接受了更多的阴道镜检查，而西班牙裔女性接受了更多的 LEEP。尽管在我们的队列中癌症罕见，但种族之间的癌症发生率没有统计学差异。
