Projected Impact of HPV and LBC Primary Testing on Rates of Referral for Colposcopy in a Canadian Cervical Cancer Screening Program
Autor: | David Quinlan, Gavin Stuart, Laurie Smith, Stuart Peacock, Eduardo L. Franco, Ruth Elwood Martin, Dianne Miller, Norm Phillips, Darrel Cook, Mel Krajden, Gina Ogilvie, Dirk van Niekerk, Andrew J. Coldman, Thomas Ehlen |
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Rok vydání: | 2015 |
Předmět: |
Adult
medicine.medical_specialty Referral Cytodiagnosis Population Uterine Cervical Neoplasms Cervical cancer screening Sensitivity and Specificity law.invention Randomized controlled trial law Conventional cytology medicine Humans Mass Screening education Referral and Consultation Early Detection of Cancer Aged Vaginal Smears Gynecology Colposcopy education.field_of_study British Columbia medicine.diagnostic_test business.industry Obstetrics Papillomavirus Infections Obstetrics and Gynecology Middle Aged Hpv testing Female Triage Abnormal results business |
Zdroj: | Journal of Obstetrics and Gynaecology Canada. 37:412-420 |
ISSN: | 1701-2163 |
Popis: | Objective To estimate the impact of implementing primary human papilloma virus liquid-based cytology (LBC) screening on four-year rates of referral for colposcopy in the British Columbia screening program. Methods We used data on referral for colposcopy from an RCT (HPV FOCAL) comparing HPV testing every four years with LBC testing every two years. We also used data from population screening with conventional cytology among women aged 25 to 69. The predicted effect of adoption of either trial protocol on rates of referral for colposcopy was estimated using trial age-specific result and screening result-specific rates weighted by their screening program distribution. The cumulative age-specific rates of referral for colposcopy over four years were calculated. Results Use of HPV testing initially increased rates of referral for colposcopy in the trial, but over four years the cumulative rates of referral were similar to those for LBC except in women aged 25 to 29, in whom a substantial excess persisted. Four-year rates of referral for colposcopy declined with age in women screened with HPV testing, LBC, and conventional cytology. Extrapolating the trial results to the distribution in the provincial screening program, implementation of either HPV or LBC throughout the provincial population would approximately double the current rates of referral for colposcopy. Conclusion Compared with LBC screening, primary screening for HPV increased rates of referral for colposcopy only among women aged 25 to 29. In contrast to current practice, referral for colposcopy was largely driven by the trial protocol recommendations for the management of abnormal results and not by which screening test was used. |
Databáze: | OpenAIRE |
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