Olthof E M G, Aitken C A, Siebers A G, van Kemenade F J, de Kok I M C M
Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Int J Cancer. 2024 Jun 15;154(12):2132-2141. doi: 10.1002/ijc.34902. Epub 2024 Mar 4.
Loss to follow-up (LTFU) within cervical screening programmes can result in missed clinically relevant lesions, potentially reducing programme effectiveness. To examine the health impact of losing women during the screening process, we determined the proportion of women LTFU per step of the Dutch hrHPV-based screening programme. We then determined the probability of being LTFU by age, screening history and sampling method (self- or clinician-sampled) using logistic regression analysis. Finally, we estimated the number of missed CIN2+/3+ lesions per LTFU moment by using the CIN-risk in women compliant with follow-up. Data from the Dutch nationwide pathology databank (Palga) was used. Women eligible for screening in 2017 and 2018 were included (N = 840,428). For clinician collected (CC) samples, the highest proportion LTFU was found following 'referral advice for colposcopy' (5.5% after indirect referral; 3.8% after direct referral). For self-sampling, the highest proportions LTFU were found following the advice for repeat cytology (13.6%) and after referral advice for colposcopy (8.2% after indirect referral; 4.3% after direct referral). Self-sampling users and women with no screening history had a higher LTFU-risk (OR: 3.87, CI: 3.55-4.23; OR: 1.39, CI: 1.20-1.61) compared to women that used CC sampling and women that have been screened before, respectively. Of all women LTFU in 2017/18, the total number of potentially missed CIN2+ was 844 (21% of women LTFU). Most lesions were missed after 'direct referral for colposcopy' (N = 462, 11.5% of women LTFU). So, this indicates a gap between the screening programme and clinical care which requires further attention, by improving monitoring of patients after referral.
宫颈癌筛查项目中的失访情况可能导致错过具有临床意义的病变，从而可能降低项目效果。为了研究在筛查过程中失去女性受检者所产生的健康影响，我们确定了荷兰基于高危型人乳头瘤病毒（hrHPV）的筛查项目每一步骤中失访女性的比例。然后，我们使用逻辑回归分析，根据年龄、筛查史和采样方法（自我采样或临床医生采样）确定失访的概率。最后，我们通过使用依从随访的女性的CIN风险，估计每个失访时刻错过的CIN2 + / 3 +病变的数量。使用了来自荷兰全国病理数据库（Palga）的数据。纳入了2017年和2018年符合筛查条件的女性（N = 840,428）。对于临床医生采集（CC）的样本，在“阴道镜检查转诊建议”之后发现失访比例最高（间接转诊后为5.5％；直接转诊后为3.8％）。对于自我采样，在重复细胞学检查建议之后以及阴道镜检查转诊建议之后发现失访比例最高（间接转诊后为8.2％；直接转诊后为4.3％）。与使用CC采样的女性和之前接受过筛查的女性相比，自我采样使用者和无筛查史的女性失访风险更高（OR：3.87，CI：3.55 - 4.23；OR：1.39，CI：1.20 - 1.61）。在2017/18年所有失访的女性中，潜在错过CIN2 +的总数为844例（占失访女性的21％）。大多数病变在“直接转诊阴道镜检查”之后被错过（N = 462，占失访女性的11.5％）。因此，这表明筛查项目与临床护理之间存在差距，需要通过改善转诊后患者的监测来进一步关注。
