Benefit and burden in the Dutch cytology-based vs high-risk human papillomavirus-based cervical cancer screening program

Autor: Albert G. Siebers, Lisanne M. Koenjer, Diede L. Loopik, Ruud L.M. Bekkers, Willem J. G. Melchers
Přispěvatelé: RS: GROW - R2 - Basic and Translational Cancer Biology, Obstetrie & Gynaecologie
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Biopsy
Uterine Cervical Neoplasms
Medical Overuse
0302 clinical medicine
Cytology
030212 general & internal medicine
Overdiagnosis
Referral and Consultation
Early Detection of Cancer
Netherlands
Colposcopy
Cervical cancer
Women's cancers Radboud Institute for Molecular Life Sciences [Radboudumc 17]
030219 obstetrics & reproductive medicine
medicine.diagnostic_test
Obstetrics
colposcopy
Obstetrics and Gynecology
WOMEN
Middle Aged
Women's cancers Radboud Institute for Health Sciences [Radboudumc 17]
Female
Squamous Intraepithelial Lesions of the Cervix
Papanicolaou Test
Adult
medicine.medical_specialty
HPV
Referral
Electrosurgery
Cervical intraepithelial neoplasia
Specimen Handling
03 medical and health sciences
Population screening
All institutes and research themes of the Radboud University Medical Center
Atypical Squamous Cells of the Cervix
medicine
Humans
Vaginal Smears
Overtreatment
business.industry
Papillomavirus Infections
Retrospective cohort study
Odds ratio
cervical smear
Uterine Cervical Dysplasia
medicine.disease
EFFICACY
Self Care
business
Zdroj: American Journal of Obstetrics and Gynecology, 224(2):ARTN 200.e1-e9, 200.e1-200.e9. MOSBY-ELSEVIER
American Journal of Obstetrics and Gynecology, 224
American Journal of Obstetrics and Gynecology, 224, 2
ISSN: 0002-9378
Popis: Background In 2017, the Dutch cervical cancer screening program had replaced the primary cytology-based screening with primary high-risk human papillomavirus-based screening, including the opportunity to participate through self-sampling. Evaluation and balancing benefit (detection of high-grade cervical intraepithelial neoplasia) and burden of screening (unnecessary referrals, invasive diagnostics, and overtreatment) is needed. Objective This study aimed to compare the referral rates, detection of high-grade cervical intraepithelial neoplasia, overdiagnosis, and overtreatment in the new high-risk human papillomavirus-based screening program, including physician-sampled and self-sampled material, with the previous cytology-based screening program in the Netherlands. Study Design A retrospective cohort study was conducted within the Dutch population-based cervical cancer screening program. Screenees with referrals for colposcopy between 2014 and 2015 (cytology-based screening) and 2017 and 2018 (high-risk human papillomavirus-based screening) were included. Data were retrieved from the Dutch Pathology Registry (PALGA) and compared between the 2 screening programs. The main outcome measures were referral rate, detection of high-grade cervical intraepithelial neoplasia or worse, overdiagnosis (cervical intraepithelial neoplasia grade 1 or less in the histologic specimen), and overtreatment (cervical intraepithelial neoplasia grade 1 or less in the treatment specimen). Results Of the women included in the study, 19,109 received cytology-based screening, and 26,171 received high-risk human papillomavirus-based screening. Referral rates increased from 2.5% in cytology-based screening to 4.2% in high-risk human papillomavirus-based screening (+70.2%). Detection rates increased to 46.2% for cervical intraepithelial neoplasia grade 2 or worse, 32.2% for cervical intraepithelial neoplasia grade 3 or worse, and 31.0% for cervical cancer, and overdiagnosis increased to 143.4% with high-risk human papillomavirus-based screening. Overtreatment rates were similar in both screening periods. The positive predictive value of referral for detection of cervical intraepithelial neoplasia grade 2 or worse in high-risk human papillomavirus-based screening was 34.6% compared with 40.2% in cytology-based screening. Women screened through self-sampling were at higher risk of cervical intraepithelial neoplasia grade 2 or worse detection (odds ratio, 1.38; 95% confidence interval, 1.20–1.59) and receiving treatment (odds ratio, 1.31; 95% confidence interval, 1.16–1.48) than those screened through physician-sampling. Conclusion Compared with cytology-based screening, high-risk human papillomavirus-based screening increases detection of high-grade cervical intraepithelial neoplasia, with 462 more cervical intraepithelial neoplasia grade 2 or worse cases per 100,000 women but at the expense of 850 more cases per 100,000 women with invasive diagnostics indicating cervical intraepithelial neoplasia grade 1 or less.
Databáze: OpenAIRE
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