Kulasingam Shalini L, de Kok Inge M C M, Mehta Abhinav, Jansen Erik E L, Regan Mary Caroline, Killen James W, Sy Stephen, Zhao Ran, Canfell Karen, Kim Jane J, Smith Megan A, Campos Nicole G
Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis.
Erasmus University Medical Center, Rotterdam, the Netherlands.
JAMA Netw Open. 2025 Mar 3;8(3):e250479. doi: 10.1001/jamanetworkopen.2025.0479.
Cervical screening guidelines in the US recommend that most females can exit routine screening at age 65 years following 2 recent consecutive negative cotest results (concurrent human papillomavirus and cytology tests). However, empirical data on the subsequent risks of cancer and cancer death in this subgroup of females are limited.
To estimate the risks of cervical cancer and cervical cancer death among females who meet the cotesting criteria to exit screening.
DESIGN, SETTING, AND PARTICIPANTS: In this decision analytical comparative modeling study, 4 decision analytical models from the Cancer Intervention and Surveillance Modeling Network-Cervical modeling consortium that fit common US epidemiological data targets were validated against published estimates of 3- and 5-year risks of cervical intraepithelial neoplasia grade 3 (CIN3) among females meeting exit criteria at Kaiser Permanente Northern California (KPNC).
Age-conditional and cumulative risks of cervical cancer and cervical cancer death at ages 65, 70, 75, 80, and 85 years were estimated by performing a comparative modeling analysis of the 4 models to estimate the risks of cervical cancer and cervical cancer death after exiting screening.
All models estimated a 5-year risk of CIN3 that was within the range of empirical data from KPNC. Projections of the cumulative and age-conditional risks of cervical cancer and cervical cancer death increased with time since exiting screening. The cumulative risks of cervical cancer and cervical cancer death by age 70 years were estimated to range from 0.001% to 0.003% and from 0% to 0.001%, respectively. The cumulative risks of cervical cancer and cervical cancer death by age 85 years ranged from 0.026% to 0.081% and from 0.005% to 0.038%, respectively, across models. Results were sensitive to assumptions about screening test sensitivity and incidence of high-risk human papillomavirus.
In this decision analytical comparative modeling study, a low risk of cervical cancer and cervical cancer death was estimated among females who fulfilled the US criteria to exit screening with cotesting; however, the risks increased with age and/or time since screening exit. The findings suggest that future guidelines should consider acceptable risk levels when defining screening modality and exit age requirements.
美国的宫颈癌筛查指南建议，大多数女性在最近连续两次联合检测结果（同时进行人乳头瘤病毒和细胞学检测）呈阴性后，可在65岁时停止常规筛查。然而，关于该女性亚组后续患癌风险和癌症死亡风险的实证数据有限。
评估符合联合检测标准可停止筛查的女性患宫颈癌和宫颈癌死亡的风险。
设计、背景和参与者：在这项决策分析比较建模研究中，对癌症干预与监测建模网络-宫颈癌建模联盟的4个符合美国常见流行病学数据目标的决策分析模型，根据北加利福尼亚凯撒医疗集团（KPNC）中符合停止筛查标准的女性中已发表的3年和5年宫颈上皮内瘤变3级（CIN3）风险估计值进行了验证。
通过对4个模型进行比较建模分析，以估计停止筛查后患宫颈癌和宫颈癌死亡的风险，从而估计65、70、75、80和85岁时宫颈癌和宫颈癌死亡的年龄条件风险和累积风险。
所有模型估计的CIN3 5年风险均在KPNC的实证数据范围内。宫颈癌和宫颈癌死亡的累积风险及年龄条件风险预测值随停止筛查后的时间增加而升高。到70岁时，宫颈癌和宫颈癌死亡的累积风险估计分别为0.001%至0.003%和0%至0.001%。各模型中，到85岁时，宫颈癌和宫颈癌死亡的累积风险分别为0.026%至0.081%和0.005%至0.038%。结果对筛查检测敏感性和高危人乳头瘤病毒发病率的假设敏感。
在这项决策分析比较建模研究中，估计符合美国联合检测停止筛查标准的女性患宫颈癌和宫颈癌死亡的风险较低；然而，这些风险会随着年龄增长和/或停止筛查后的时间增加。研究结果表明，未来指南在定义筛查方式和停止筛查年龄要求时应考虑可接受的风险水平。
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