在初级保健中进行宫癌查:美国预防服务工作组的决策分析
Jane J Kim1, Emily A Burger1,2, Catherine Regan1
1Department of Health Policy and Management, Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
JAMA
|August 25, 2018
概括
每5年进行一次高风险人乳头瘤病毒 (hrHPV) 初级检测,为宫癌查提供了良好的好坏平衡. 在30岁时从细胞学转换为hrHPV检测显示出最有效的危害益处比率.
科学领域:
- 妇科医生
- 癌症学
- 公共卫生
背景情况:
- 宫癌查指南要求对初级高危人乳头瘤病毒 (hrHPV) 检测的益处和危害提供证据.
- 目前的查依赖于细胞学,但 hrHPV 检测提供了潜在的改善.
研究的目的:
- 模拟各种宫癌查策略的好处和危害.
- 根据美国预防服务工作组的建议.
主要方法:
- 一个微模拟模型对一个假设的女性队列评估了19种查策略.
- 策略包括细胞学,hrHPV测试和联合测试,年龄的变化,重新查间隔和分类方法.
- 测量结果包括测试,结肠镜,疾病检测,错误阳性,癌症病例/死亡和寿命.
主要成果:
- 与没有查相比,所有模拟策略都显著减少了宫癌病例和死亡.
- 主要的HRHPV检测和联合检测策略显示出略高的有效性,但也比单独的细胞检测有更大的危害.
- 每5年一次的初级HPV检测是有效的,在30岁时进行切换会产生最佳的危害益处比率 (每增加一年的结肠镜检查).
结论:
- 每5年一次的初级HPV查似乎提供了合理的危害和益处平衡.
- 在30岁时从细胞学转向HPV检测是最有效的策略.
- 这些发现可以为更新的宫癌查指南提供信息.
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