Dysplasia of the uterine cervix.Incidence of regression, recurrence, and cancer

Stern, Elizabeth; Neely, P M

doi:10.1002/1097-0142(196404)17:4<508::aid-cncr2820170412>3.0.co;2-s

Cited by 66 publications

(14 citation statements)

References 4 publications

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“…for all pre-invasive abnormalities of the cervix (Richart & Barron, 1969;Koss, 1978 (Rotkin, 1973) or their partner (Skegg et al, 1982) The incidence of dysplasia (transfer 1 to 2) is derived from observed data (Dunn & Martin, 1967;Parkin et al, 1982b), and transition from clinical cancer to death (5 to 8) is derived from age/duration-specific survival rates for England and Wales (OPCS, 1980). Dysplasia is a relatively transient condition, and the high regression rates (2 to 1) used here (12.5-25% per year) are consistent with observed data (Stern & Neely, 1964;Fox, 1967;Nasiell et al, 1976). In HI c.i.s.…”

Section: Simulation Of the Disease Processsupporting

confidence: 91%

A computer simulation model for the practical planning of cervical cancer screening programmes

Dm¹

1985

Br J Cancer

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Summary There is ample evidence of the efficacy of cytological screening in the prevention of cervical cancer but disagreement on the form which screening programmes should take. Simulation models have been used as a convenient and rapid method of exploring the outcome of different screening policies and of demonstrating the importance and interrelationships of the variables concerned. However, most such models are either too abstract or too simplistic to be of practical value in planning screening programmes.A model is described which reproduces demographic events in a female population (that of England and Wales) over a 30 year period, and onto this superimposes the natural history of cervical carcinoma, using data derived from published studies. A microsimulation approach -each individual in the population being retained as a unit -allows factors such as disease onset and screening uptake to be dependent upon personal characteristics and past events. Screening can be offered as part of a routine programme, or incidentally -for example during pregnancy or hospital attendance.The model allows quantitative evaluation of the complex patterns of screening that are actually observed and the relative importance of the different components of such screening programmes. Assumptions about natural history can thus be studied.Cervical cytology screening is an effective means of reducing the incidence of invasive cancer of the cervix (Guzick, 1978;. However, the decision to introduce a screening programme into a population will depend upon considerations of the degree of benefit obtainable in relation to the resources deployed and this ratio will vary considerably with the actual programme design (who is to be examined, where, and how often). The utility of randomised trials to evaluate complex programmes involving repeated examinations and follow-up of large numbers of subjects is limited by the time and expense involved. It is possible to investigate only a limited number of screening schedules and the methodology used may be deemed obsolete or inappropriate by the time results become available. Finally, the apparently obvious benefit to be gained from early diagnosis means that it is difficult to convince physicians and their patients of the need for a controlled trial, so that they may be judged unethical, or the control group receive screening outside the trial.Health care models are a convenient way of predicting the results of different interventions, given varying assumptions about the relationships involved. Their advantages have been summarised by Eddy & Schwartz (1982 Coppleson & Brown (1975) is the simplest, a Markov process using just 4 states (normal, dysplasia, carcinoma in situ (c.i.s.) and invasive cancer) and a set of transition rates between them compatible with observed cross-sectional data on incidence and prevalence of the preclinical states (Bibbo et al., 1971), and cumulative incidence of clinical cancer (Cutler & Young, 1975 An identical approach using the same model has recently been published b...

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Section: Simulation Of the Disease Processsupporting

confidence: 91%

A computer simulation model for the practical planning of cervical cancer screening programmes

Dm¹

1985

Br J Cancer

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“…Women with a normal cervix may be suitable for discharge, but the safety of such a policy is uncertain. Those with a low grade lesion may be suitable for surveillance by repeated attendance at a clinic, aimed at monitoring the abnormalities in the hope that they resolve 4 – 8. Attendance at a colposcopy clinic, however, is a likely cause of significant anxiety 9.…”

Section: Introductionmentioning

confidence: 99%

Management guidelines for women with normal colposcopy after low grade cervical abnormalities: population study

Teale

Moffitt²,

Mann³

et al. 2000

BMJ

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Objectives To develop an evidence based protocol for the follow up of women with low grade cervical abnormalities for whom treatment is not immediately indicated. Design Population outcome study. Setting Colposcopy clinic of an inner city teaching hospital. Participants 566 women with low grade cytological abnormalities who were not treated at a first visit to the colposcopy clinic, followed up for a total of 881 years. Main outcome measures Resolution of abnormalities, persistence of disease, and treated disease. Results Abnormalities resolved in 306 (54.1%) women, whereas 138 (24.4%) had persistent disease and 122 (21.5%) were subsequently treated. Colposcopic opinion, smear test results, age, smoking history, and number of pregnancies were all significantly related to outcome. Logistic regression analysis produced a model that correctly identified 70% of women whose abnormalities resolved. Only 23 of 295 women (7.8%) with a normal cervix on colposcopy and a smear without dyskaryosis at a first visit were treated by the end of the observation period. Conclusions Women referred with low grade cytological abnormalities who have a normal cervix on colposcopy and a negative or borderline repeat smear test result may be discharged from the colposcopy clinic. We propose a follow up protocol that could safely avoid unnecessary visits to a clinic.

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“…LGSIL of the Bethesda system, which expresses it as a reactive change following HPV infection, has been believed to regress spontaneously, and many earlier studies report high spontaneous regression rates; see Table 5[7–14] and Table 6[15–25]. Spontaneous regression rates vary depending on the type of follow‐up method used.…”

Section: Discussionmentioning

confidence: 99%