Clinical progression of high-grade cervical intraepithelial neoplasia: estimating the time to preclinical cervical cancer from doubly censored national registry data

Little is known about the time span of progression from high-grade cervical intraepithelial neoplasia (CIN2/3) to invasive cervical cancer. Estimation of this duration from longitudinal studies is not permitted, as CIN2/3 should be treated when detected. Cross-sectional data on the age-specific inci...

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Veröffentlicht in:American journal of epidemiology Jg. 178; H. 7; S. 1161
Hauptverfasser: Vink, Margaretha A, Bogaards, Johannes A, van Kemenade, Folkert J, de Melker, Hester E, Meijer, Chris J L M, Berkhof, Johannes
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.10.2013
Schlagworte:
Adolescent
Adult
Aged
Aged, 80 and over
Cervical Intraepithelial Neoplasia - pathology
Cervical Intraepithelial Neoplasia - physiopathology
Child
Cross-Sectional Studies
Disease Progression
Early Detection of Cancer
Female
Human papillomavirus 16 - genetics
Humans
Incidence
Middle Aged
Models, Statistical
Papanicolaou Test
Precancerous Conditions - pathology
Precancerous Conditions - physiopathology
Registries
Time Factors
Uterine Cervical Neoplasms - pathology
Uterine Cervical Neoplasms - physiopathology
doubly censored data
human papillomavirus
disease progression
registries
cervical cancer
natural history
cervical intraepithelial neoplasia
mover-stayer model
ISSN:1476-6256, 1476-6256
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Zusammenfassung:Little is known about the time span of progression from high-grade cervical intraepithelial neoplasia (CIN2/3) to invasive cervical cancer. Estimation of this duration from longitudinal studies is not permitted, as CIN2/3 should be treated when detected. Cross-sectional data on the age-specific incidence of detected CIN2/3 and cervical cancer cases are readily available in national registries, but these data are difficult to interpret because neither the moment of lesion development nor the onset of invasive cancer is observed. We developed a statistical model for estimating the duration of time between CIN2/3 and preclinical cancer using Dutch national registries for the years 2000-2005. Human papillomavirus (HPV) genotype data were used to separate CIN2/3 and cancer incidences to obtain estimates for HPV-16-positive and HPV-16-negative lesions. The median time from CIN2/3 to cancer was estimated to be 23.5 years (95% confidence interval: 20.8, 26.6), and 1.6% of the lesions progressed to cancer within 10 years. The median duration for HPV-16-positive lesions was similar, but 2.4% of the HPV-16-positive lesions progressed to cancer within 10 years, as compared with 0.6% for HPV-16-negative lesions. Estimated durations of time to cancer are essential for reassessment of the optimal screening interval in light of vaccination and novel screening tests.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1476-6256
1476-6256
DOI:10.1093/aje/kwt077