Colposcopy referral rates post-introduction of primary screening with human papillomavirus testing: evidence from a large British Columbia cohort study.

Autor:	Gottschlich A; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, BC, Canada.; Wayne State University, School of Medicine Departments of Oncology, Detroit, MI, USA.; Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA., Gondara L; Cervical Cancer Screening Program, British Columbia Cancer Agency, Vancouver, BC, Canada., Smith LW; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, BC, Canada.; Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC, Canada., Anderson JJ; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, BC, Canada.; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada., Cook D; British Columbia Centre for Disease Control, Vancouver, BC, Canada., Krajden M; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.; Lower Mainland Laboratories, Vancouver, BC, Canada., Lee M; Cervical Cancer Screening Program, British Columbia Cancer Agency, Vancouver, BC, Canada., Martin RE; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada., Melnikow J; Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA, USA., Peacock S; Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC, Canada.; Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.; Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada., Proctor L; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, BC, Canada.; Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC, Canada.; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada., Stuart G; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada., Franco EL; Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada., van Niekerk D; Cervical Cancer Screening Program, British Columbia Cancer Agency, Vancouver, BC, Canada.; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada., Ogilvie GS; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, BC, Canada.; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.; British Columbia Centre for Disease Control, Vancouver, BC, Canada.
Jazyk:	angličtina
Zdroj:	Lancet regional health. Americas [Lancet Reg Health Am] 2023 Sep 29; Vol. 26, pp. 100598. Date of Electronic Publication: 2023 Sep 29 (Print Publication: 2023).
DOI:	10.1016/j.lana.2023.100598
Abstrakt:	Background: Shifting from cytology to human papillomavirus (HPV)-based cervical cancer screening will initially increase colposcopy referrals. The anticipated impact on health systems has been raised as a concern for implementation. It is unclear if the higher rate of colposcopy referrals is sustained after initial HPV-based screens or reverts to new lower baselines due to earlier detection and treatment of precancer. This study aimed to investigate long-term rates of colposcopy referrals after participation in HPV-based screening. Methods: Participants of HPV for Cervical Cancer Screening trial (HPV FOCAL) received one (HPV1, N = 6204) or two (HPV2, N = 9540) HPV-based screens. After exit, they returned to British Columbia's (BC) cytology screening program. A comparison cohort from the BC screening population (BCS, N = 1,140,745) was identified, mirroring trial inclusion criteria. All participants were followed for 10-14 years through the provincial screening registry. Colposcopy referral rates per 1000 screens were calculated for each group. Trial colposcopy referrals for HPV1 and HPV2 were calculated under two referral scenarios: (1) all HPV positive referred to colposcopy; (2) cytology triage with ASCUS or greater referred to colposcopy. Colposcopy referrals from post-trial screens in HPV1 an HPV2 and all screens in BCS were based on actual recommendations from the screening program. A multivariable flexible survival regression model compared hazard ratios (HR) throughout follow-up. Findings: Scenario 2 referral rates were higher during initial HPV screen(s) vs cytology screen (HPV1: 28 per 1000 screens (95% CI: 24, 33), HPV2: 32 per 1000 screens (95% CI: 29, 36), BCS: 8 per 1000 screens (95% CI: 8.9)). However, post-trial rates in HPV1 and HPV2 were significantly lower than in BCS. Cumulative rates in HPV1 and HPV2 approached the cumulative rate in BCS 11-12 years after HPV-based screening (HPV1: 11 per 1000 screens (95% CI: 10, 12), HPV2: 16 per 1000 screens (95% CI: 15-17), BCS: 11 per 1000 screens (95% CI: 10, 11)). Adjusted models demonstrated reductions in referral rates in HPV1 (HR = 0.6, 95% CI: 0.5, 0.7) and HPV2 (HR = 0.7, 95% CI: 0.6, 0.8) relative to BCS by 54 and 72 months post-final HPV screen respectively. Interpretation: Reduced colposcopy referral rates were observed after initial rounds of HPV-based screening. After initial HPV screening, referral rates to colposcopy after cytology triage were below the current rates seen in a centralized cytology program after approximately four years. Any expected increase in referrals at initiation of HPV-based screening could be countered by staged program implementation. Funding: This work was supported by the National Institutes of Health (R01 CA221918), Michael Smith Health Research BC (RT-2021-1595), and the Canadian Institutes of Health Research (MCT82072). Competing Interests: AG received grant funding and travel support from Michael Smith Health Research BC (RT-2021-1595). LG has no disclosures. LS received a one-time consulting fee stipend for participation in a workgroup for BD Canada on cervical cancer elimination in Canada. JA has no disclosures. DC has no disclosures. MK has no disclosures. ML received honoraria for presentations/educational events with Merck in January of 2023. RM has no disclosures. JM received sub-award funding from the National Institutes of Health (R01 CA221918). SP has no disclosures. LP has no disclosures. GS has no disclosures. EF received consulting fees from Merck and BD and has a patent registered at the Office of Innovation and Partnerships at McGill University Montreal, Quebec, Canada (DNA methylation markers for early detection of cervical cancer, October 2018). DV has no disclosures. GO received grant funding from the National Institutes of Health (R01 CA221918) and the Canadian Institute of Health Research (MCT82072). (© 2023 The Author(s).)
Databáze:	MEDLINE
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