Absolute risks of cervical precancer among women who fulfill exiting guidelines based on HPV and cytology cotesting

Autor: Rebecca Landy, Philip E. Castle, Nancy E. Poitras, Hormuzd A. Katki, Thomas Lorey, Walter Kinney, Nicolas Wentzensen, Mark Schiffman, Greg Rydzak, Li C. Cheung, Peter Sasieni
Rok vydání: 2019
Předmět:
Zdroj: International Journal of Cancer
Landy, R, Schiffman, M, Sasieni, P D, Cheung, L C, Katki, H A, Rydzak, G, Wentzensen, N, Poitras, N E, Lorey, T, Kinney, W K & Castle, P E 2020, ' Absolute risks of cervical precancer among women who fulfill exiting guidelines based on HPV and cytology cotesting ', International Journal of Cancer, vol. 146, no. 3, pp. 617-626 . https://doi.org/10.1002/ijc.32268
ISSN: 1097-0215
0020-7136
DOI: 10.1002/ijc.32268
Popis: US guidelines recommend that most women older than 65 years cease cervical screening after two consecutive negative cotests (concurrent HPV and cytology tests) in the previous 10 years, with one in the last 5 years. However, this recommendation was based on expert opinion and modeling rather than empirical data on cancer risk. We therefore estimated the 5‐year risks of cervical precancer (cervical intraepithelial neoplasia grade 3 or adenocarcinoma in situ [CIN3]) after one, two and three negative cotests among 346,760 women aged 55–64 years undergoing routine cotesting at Kaiser Permanente Northern California (2003–2015). Women with a history of excisional treatment or CIN2+ were excluded. No woman with one or more negative cotests was diagnosed with cancer during follow‐up. Five‐year risks of CIN3 after one, two, and three consecutive negative cotests were 0.034% (95% CI: 0.023%–0.046%), 0.041% (95% CI: 0.007%–0.076%) and 0.016% (95% CI: 0.000%–0.052%), respectively (p trend < 0.001). These risks did not appreciably differ by a positive cotest result prior to the one, two or three negative cotest(s). Since CIN3 risks after one or more negative cotests were significantly below a proposed 0.12% CIN3+ risk threshold for a 5‐year screening interval, a longer screening interval in these women is justified. However, the choice of how many negative cotests provide sufficient safety against invasive cancer over a woman's remaining life represents a value judgment based on the harms versus benefits of continued screening. Ideally, this guideline should be informed by longer‐term follow‐up given that exiting is a long‐term decision.
What's new? US guidelines recommend that women older than 65 years cease screening for cervical cancer following two consecutive negative cotests (HPV and cytology) in the previous ten years. However, these guidelines are based on modelling and expert opinion, rather than empirical data. In this large epidemiological study, the authors estimated the risks of cervical precancer following one, two, or three negative cotests among women aged 55‐64 years. They caution that the optimal time for women to exit screening represents a value judgment, based on the harms versus benefits of continued screening. Further data are needed.
Databáze: OpenAIRE
Externí odkaz: