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Halpern MT, Liu B, Lowy DR, Gupta S, Croswell JM, Doria-Rose VP. The Annual Cost of Cancer Screening in the United States. Ann Intern Med 2024. [PMID: 39102723 DOI: 10.7326/m24-0375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Cancer has substantial health, quality-of-life, and economic impacts. Screening may decrease cancer mortality and treatment costs, but the cost of screening in the United States is unknown. OBJECTIVE To estimate the annual cost of initial cancer screening (that is, screening without follow-up costs) in the United States in 2021. DESIGN Model using national health care survey and cost resources data. SETTING U.S. health care systems and institutions. PARTICIPANTS People eligible for breast, cervical, colorectal, lung, and prostate cancer screening with available data. MEASUREMENTS The number of people screened and associated health care system costs by insurance status in 2021 dollars. RESULTS Total health care system costs for initial cancer screenings in the United States in 2021 were estimated at $43 billion. Approximately 88.3% of costs were attributable to private insurance; 8.5% to Medicare; and 3.2% to Medicaid, other government programs, and uninsured persons. Screening for colorectal cancer represented approximately 64% of the total cost; screening colonoscopy represented about 55% of the total. Facility costs (amounts paid to facilities where testing occurred) were major drivers of the total estimated costs of screening. LIMITATIONS All data on receipt of cancer screening are based on self-report from national health care surveys. Estimates do not include costs of follow-up for positive or abnormal screening results. Variations in costs based on geography and provider or health care organization are not fully captured. CONCLUSION The $43 billion estimated annual cost for initial cancer screening in the United States in 2021 is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Michael T Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.)
| | - Benmei Liu
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.)
| | - Douglas R Lowy
- Office of the Director, National Cancer Institute, Bethesda, Maryland (D.R.L.)
| | - Samir Gupta
- VA San Diego Healthcare System, San Diego, California, and UC San Diego Division of Gastroenterology and Cancer Control Program, Moores Cancer Center, University of California San Diego, La Jolla, California (S.G.)
| | - Jennifer M Croswell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.)
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.)
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Paek SC, Zhang NJ. Factors associated with the use of annual health checkups in Thailand: evidence from a national cross-sectional health and welfare survey. Front Public Health 2024; 12:1390125. [PMID: 38799693 PMCID: PMC11116713 DOI: 10.3389/fpubh.2024.1390125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Thailand has provided free annual health checkups (AHC) since universal health coverage began in 2002. However, evidence regarding the equitable use of AHC is scarce. Thus, this study explored factors associated with the use of AHC in Thailand. Methods A cross-sectional study was conducted using data from the national 2015 Health and Welfare Survey. Respondents aged 15 years or above (n = 57,343) were selected as the study sample. Descriptive statistical analysis and multivariable binary logistic regression were conducted to examine the association between the use of AHC and factors selected on the basis on Andersen's Behavioral Model of Access to Medical Care. Results Among the study sample, approximately 4.9% (n = 2,815) had used AHC during the past year. Regarding predisposing factors, the use of AHC was positively related to age (e.g., over 61 vs. 15-30: AOR = 2.90 [95% CI = 2.40-3.52], p < 0.001) and female sex (AOR = 1.23 [95% CI = 1.12-1.35] p < 0.001). For enabling factors, the AHC use was positively associated with income (e.g., Q4 vs. Q1: AOR = 1.98 [95% CI = 1.75-2.25], p < 0.001), education (e.g., high vs. low: AOR = 3.11 [95% CI = 2.75-3.51], p < 0.001), being married (e.g., vs. single: AOR = 1.27 [95% CI = 1.11-1.46], p < 0.001), and urban residency (AOR = 1.12 [95% CI = 1.04-1.22], p = 0.006). For need-for-care factors, the AHC use was positively related to chronic disease (AOR = 1.26 [95% CI = 1.15-1.38], p < 0.001), non-smoking (e.g., vs. daily: AOR = 1.18 [95% CI = 1.03-1.36], p = 0.015), non-drinking (e.g., vs. 3-4 times per week: AOR = 1.26 [95% CI = 1.04-1.53], p = 0.016), and vegetable consumption (e.g., over 5 ladles vs. below 1 ladle: AOR = 1.86 [95% CI = 1.50-2.31], p < 0.001). Conclusion The results indicate that health awareness could play a significant role in the use of AHC. Individuals with high socioeconomic status (e.g., high-income people) and those with low-risk health behaviors (e.g., non-smokers) generally have a high interest in health and well-being. This may have been the primary reason for the high use of AHC among these groups. Thus, the government should continue to promote the public's health awareness through various public campaigns and education programs to increase the use of AHC.
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Affiliation(s)
- Seung Chun Paek
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
- Health Solution Research Unit, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - Ning Jackie Zhang
- College of Health Professions, Grand Valley State University, Grand Rapids, MI, United States
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Narcisse MR, McElfish PA, Hallgren E, Pierre-Joseph N, Felix HC. Non-use and inadequate use of cervical cancer screening among a representative sample of women in the United States. Front Public Health 2024; 12:1321253. [PMID: 38711762 PMCID: PMC11070477 DOI: 10.3389/fpubh.2024.1321253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/18/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction Women's adherence to the United States (U.S.) Preventive Services Task Force guidelines for cervical cancer screening was determined by examining predisposing, enabling, and needs factors from Andersen's Behavioral Model of Health Services Use conceptual framework. Methods The outcome was operationalized as cervical cancer screening use, non-use, and inadequate-use. Multinomial logistic regression was conducted on data from the 2019 National Health Interview Survey of 7,331 eligible women aged 21-65. Results Compared with women who used cervical cancer screening services, women aged 30-65 were less likely to be Non-Users than those aged 21-29. Hispanic, Asian, and American Indian/Alaska Native (AIAN) women were more likely to be Non-Users than White women. More educated women were less likely to be Non-Users. Foreign-born women <10 years in the U.S. were more likely to be Non-Users than U.S.-born women. Women with financial hardship were less likely to be Non-Users. Poorer women and uninsured women were more likely to be Non-Users. Women with children in their household were less likely to be Non-Users than those without children. Women who had a well-visit in the past year were less likely to be Non-Users. Women with a history of human papillomavirus (HPV) vaccination were less likely to be Non-Users. Compared with women who used cervical cancer screening services, women aged 30-65 were less likely to be Inadequate-Users. AIAN women were more likely to be Inadequate-Users. Women of other races were less likely to be Inadequate-Users. Employed women were less likely to be Inadequate-Users. Uninsured women were more likely to be Inadequate-Users. Women who had a well-visit within a year were less likely to be Inadequate-Users. Women with past HPV vaccination were more likely to be Inadequate-Users. Smokers were less likely to be Inadequate-Users. Discussion Predisposing, enabling, and needs factors are differently associated with non-use and inadequate use of cervical cancer screening. Understanding factors associated with the use, non-use, and inadequate use of cervical cancer screening is crucial to avoid or curb unnecessary tests, increased costs to both society and individuals, and the ill-allocation of limited resources.
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Affiliation(s)
- Marie-Rachelle Narcisse
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Natalie Pierre-Joseph
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States
| | - Holly C. Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Guo Y, Szurek SM, Bian J, Braithwaite D, Licht JD, Shenkman EA. The role of sex and rurality in cancer fatalistic beliefs and cancer screening utilization in Florida. Cancer Med 2021; 10:6048-6057. [PMID: 34254469 PMCID: PMC8419763 DOI: 10.1002/cam4.4122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND People's fatalistic beliefs about cancer can influence their cancer prevention behaviors. We examined the association between fatalistic beliefs and breast and colorectal cancer screening among residents of north-central Florida and tested whether there exists any sex or rural-non-rural disparities in the association. METHODS We conducted a cross-sectional, random digit dialing telephone survey of 895 adults residing in north-central Florida in 2017. Using weighted logistic models, we examined the association between (1) respondents' sociodemographic characteristics and cancer fatalistic beliefs and (2) cancer fatalistic beliefs and cancer screening utilization among screening eligible populations. We tested a series of sex and rurality by fatalistic belief interactions. RESULTS Controlling for sociodemographics, we found the agreement with "It seems like everything causes cancer" was associated with a higher likelihood of having a mammogram (odds ratio [OR]: 3.34; 95% confidence interval [CI]: 1.17-9.51), while the agreement with "Cancer is most often caused by a person's behavior or lifestyle" was associated with a higher likelihood of having a blood stool test (OR: 1.85; 95% CI: 1.12-3.05) or a sigmoidoscopy or colonoscopy among women (OR: 2.65; 95% CI: 1.09-6.44). We did not observe any rural-non-rural disparity in the association between fatalistic beliefs and cancer screening utilization. CONCLUSIONS Some, but not all, cancer fatalistic beliefs are associated with getting breast and colorectal cancer screening in north-central Florida. Our study highlights the need for more research to better understand the social and cultural factors associated with cancer screening utilization.
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Affiliation(s)
- Yi Guo
- Department of Health Outcomes and Biomedical InformaticsCollege of MedicineUniversity of FloridaGainesvilleFLUSA
- University of Florida Health Cancer CenterGainesvilleFLUSA
| | - Sarah M. Szurek
- Department of Health Outcomes and Biomedical InformaticsCollege of MedicineUniversity of FloridaGainesvilleFLUSA
- University of Florida Health Cancer CenterGainesvilleFLUSA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical InformaticsCollege of MedicineUniversity of FloridaGainesvilleFLUSA
- University of Florida Health Cancer CenterGainesvilleFLUSA
| | - Dejana Braithwaite
- University of Florida Health Cancer CenterGainesvilleFLUSA
- Department of Aging and Geriatric ResearchCollege of MedicineUniversity of FloridaGainesvilleFLUSA
- Department of EpidemiologyCollege of Public Health and Health Professions and College of MedicineUniversity of FloridaGainesvilleFLUSA
| | - Jonathan D. Licht
- University of Florida Health Cancer CenterGainesvilleFLUSA
- Division of Hematology and OncologyDepartment of MedicineCollege of MedicineUniversity of FloridaGainesvilleFLUSA
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical InformaticsCollege of MedicineUniversity of FloridaGainesvilleFLUSA
- University of Florida Health Cancer CenterGainesvilleFLUSA
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Ratushnyak S, Hoogendoorn M, van Baal PHM. Cost-Effectiveness of Cancer Screening: Health and Costs in Life Years Gained. Am J Prev Med 2019; 57:792-799. [PMID: 31753260 DOI: 10.1016/j.amepre.2019.07.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Studies reporting on the cost-effectiveness of cancer screening usually account for quality of life losses and healthcare costs owing to cancer but do not account for future costs and quality of life losses related to competing risks. This study aims to demonstrate the impact of medical costs and quality of life losses of other diseases in the life years gained on the cost-effectiveness of U.S. cancer screening. METHODS Cost-effectiveness studies of breast, cervical, and colorectal cancer screening in the U.S. were identified using a systematic literature review. Incremental cost-effectiveness ratios of the eligible articles were updated by adding lifetime expenditures and health losses per quality-adjusted life year gained because of competing risks. This was accomplished using data on medical spending and quality of life by age and disease from the Medical Expenditure Panel Survey (2011-2015) combined with cause-deleted life tables. The study was conducted in 2018. RESULTS The impact of quality of life losses and healthcare expenditures of competing risks in life years gained incurred owing to screening were the highest for breast cancer and the lowest for cervical cancer. The updates suggest that incremental cost-effectiveness ratios are underestimated by $10,300-$13,700 per quality-adjusted life year gained if quality of life losses and healthcare expenditures of competing risks are omitted in economic evaluations. Furthermore, cancer screening programs that were considered cost saving, were found not to be so following the inclusion of medical expenditures of competing risks. CONCLUSIONS Practical difficulties in quantifying quality of life losses and healthcare expenditures owing to competing risks in life years gained can be overcome. Their inclusion can have a substantial impact on the cost-effectiveness of cancer screening programs.
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Affiliation(s)
- Svetlana Ratushnyak
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Center of Healthcare Quality Assessment and Control, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Martine Hoogendoorn
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Pieter H M van Baal
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Viscondi JYK, Faustino CG, Campolina AG, Itria A, de Soárez PC. Simple but not simpler: a systematic review of Markov models for economic evaluation of cervical cancer screening. Clinics (Sao Paulo) 2018; 73:e385. [PMID: 29995100 PMCID: PMC6024522 DOI: 10.6061/clinics/2018/e385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/26/2018] [Indexed: 12/21/2022] Open
Abstract
The aim of this study was to critically evaluate the quality of the models used in economic evaluations of screening strategies for cervical cancer prevention. We systematically searched multiple databases, selecting model-based full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses) of cervical cancer screening strategies. Two independent reviewers screened articles for relevance and performed data extraction. Methodological assessment of the quality of the models utilized formal checklists, and a qualitative narrative synthesis was performed. Thirty-eight articles were reviewed. The majority of the studies were conducted in high-income countries (82%, n=31). The Pap test was the most used screening strategy investigated, which was present in 86% (n=33) of the studies. Half of the studies (n=19) used a previously published Markov model. The deterministic sensitivity analysis was performed in 92% (n=35) of the studies. The mean number of properly reported checklist items was 9 out of the maximum possible 18. Items that were better reported included the statement of decision problem, the description of the strategies/comparators, the statement of time horizon, and information regarding the disease states. Compliance with some items of the checklist was poor. The Markov models for economic evaluation of screening strategies for cervical cancer varied in quality. The following points require improvement: 1) assessment of methodological, structural, heterogeneity, and parameter uncertainties; 2) model type and cycle length justification; 3) methods to account for heterogeneity; and 4) report of consistency evaluation (through calibration and validation methods).
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Affiliation(s)
| | | | - Alessandro Gonçalves Campolina
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alexander Itria
- Instituto de Patologia Tropical e Saude Publica, Departamento de Saude Coletiva, Nucleo de Economia e Avaliacoes da Saude, Instituto de Avaliacao de Tecnologia em Saude, Universidade Federal de Goias, Goias, GO, BR
| | - Patricia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Castellanos MR, Nehru VM, Pirog EC, Optiz L. Fluorescence microscopy of H&E stained cervical biopsies to assist the diagnosis and grading of CIN. Pathol Res Pract 2018; 214:605-611. [PMID: 29627221 DOI: 10.1016/j.prp.2018.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Prevention of cervical cancer is based upon the accurate diagnosis and grading of cervical lesions identified during screening. The pathological classification of cervical intraepithelial neoplasia (CIN) is problematic, as it relies on subjective criteria and is known to have high interobserver variability and low reproducibility. These limitations can result in either over or under treatment of patients. Biomarkers to improve CIN diagnosis have not overcome all these challenges. MAIN BODY Here we review the use of a promising optical imaging method using eosin-based fluorescence spectroscopy. This technique is able to perform fluorescent analysis of cervical biopsies directly from hematoxylin and eosin (H&E) stained tissues. Eosin is a brominated derivative of fluorescein. Fluorescence characteristics of protein-eosin complexes can demonstrate tissue changes associated with dysplasia and cancer. In this article we review the progress made towards developing eosin-based fluorescence spectroscopy. We describe the various morphologies seen among the CIN grades with this optical method and highlight the progress made to quantitate the spectral image characteristics. CONCLUSION Eosin-based fluorescence spectroscopy can be used to directly examine H&E stained tissue slides. Relevant areas can be imaged and spectral analysis done to obtain objective data to identify and grade cervical lesions.
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Affiliation(s)
- Mario R Castellanos
- Division of Research, Department of Medicine, Staten Island University Hospital - Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA.
| | - Vijeyaluxmy Motilal Nehru
- Division of Research, Department of Medicine, Staten Island University Hospital - Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA.
| | - Edyta C Pirog
- Department of Pathology, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA.
| | - Lynne Optiz
- Department of Pathology and Laboratory Medicine, Staten Island University Hospital - Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA.
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Afterword. Diagnosis (Berl) 2017. [DOI: 10.1201/9781315116334-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mendes D, Bains I, Vanni T, Jit M. Systematic review of model-based cervical screening evaluations. BMC Cancer 2015; 15:334. [PMID: 25924871 PMCID: PMC4419493 DOI: 10.1186/s12885-015-1332-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/22/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Optimising population-based cervical screening policies is becoming more complex due to the expanding range of screening technologies available and the interplay with vaccine-induced changes in epidemiology. Mathematical models are increasingly being applied to assess the impact of cervical cancer screening strategies. METHODS We systematically reviewed MEDLINE®, Embase, Web of Science®, EconLit, Health Economic Evaluation Database, and The Cochrane Library databases in order to identify the mathematical models of human papillomavirus (HPV) infection and cervical cancer progression used to assess the effectiveness and/or cost-effectiveness of cervical cancer screening strategies. Key model features and conclusions relevant to decision-making were extracted. RESULTS We found 153 articles meeting our eligibility criteria published up to May 2013. Most studies (72/153) evaluated the introduction of a new screening technology, with particular focus on the comparison of HPV DNA testing and cytology (n = 58). Twenty-eight in forty of these analyses supported HPV DNA primary screening implementation. A few studies analysed more recent technologies - rapid HPV DNA testing (n = 3), HPV DNA self-sampling (n = 4), and genotyping (n = 1) - and were also supportive of their introduction. However, no study was found on emerging molecular markers and their potential utility in future screening programmes. Most evaluations (113/153) were based on models simulating aggregate groups of women at risk of cervical cancer over time without accounting for HPV infection transmission. Calibration to country-specific outcome data is becoming more common, but has not yet become standard practice. CONCLUSIONS Models of cervical screening are increasingly used, and allow extrapolation of trial data to project the population-level health and economic impact of different screening policy. However, post-vaccination analyses have rarely incorporated transmission dynamics. Model calibration to country-specific data is increasingly common in recent studies.
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Affiliation(s)
- Diana Mendes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, UK.
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Iren Bains
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Tazio Vanni
- Brazilian Ministry of Health, Esplanada dos Ministérios Bloco G, Brasília-DF, CEP: 70058-900, Brasil.
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, UK.
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
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Zhang SK, Kang LN, Chang IJ, Zhao FH, Hu SY, Chen W, Shi JF, Zhang X, Pan QJ, Li SM, Qiao YL. The natural history of cervical cancer in chinese women: results from an 11-year follow-up study in china using a multistate model. Cancer Epidemiol Biomarkers Prev 2014; 23:1298-305. [PMID: 24789847 DOI: 10.1158/1055-9965.epi-13-0846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is important to understand the natural history of cervical cancer, which has implications for cancer prevention and management. However, a dearth of studies on the long-term development of cervical cancer exists in China. METHODS We investigated the natural history of cervical cancer in Chinese women by creating a multistate model using 11 years of follow-up data from the Shanxi Province Cervical Cancer Screening Study I conducted from 1999 to 2010. In 1999, a total of 1,997 eligible women, ages 35 to 45 years, were enrolled in Xiangyuan County, Shanxi Province. Participants were followed up in 2005 and 2010, respectively. RESULTS The average time a subject spent in CIN1 before transiting into another state was 1.4693 years [95% confidence interval (CI): 1.1215-1.9251] and the average time a subject spent in CIN2 was 2.9822 years (95% CI: 1.9790-4.4938). A subject's transition probability from CIN1 to normal increased with time. However, the transition probability from CIN1 to CIN2 was relatively lower, with 3-, 5-, and 10-year transition probabilities of 0.1415, 0.1066, and 0.0437. Comparison of 5-year transition probabilities between CIN2 to normal/CIN1 and CIN2 to CIN3(+) yielded a ratio of 2.74. CONCLUSIONS Women with CIN1 had a substantial tendency for regression. Similarly, women with CIN2 had a higher probability of regression to normal/CIN1 than progression to CIN3(+). Findings in this study may have significant implications for the development and evaluation of formal cervical cancer preventive strategies in China. IMPACT This study may serve as a valuable reference to future research on other multistate cancer processes.
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Affiliation(s)
- Shao-Kai Zhang
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Le-Ni Kang
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Irene J Chang
- Authors' Affiliations: Departments of Cancer Epidemiology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Fang-Hui Zhao
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Shang-Ying Hu
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Wen Chen
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Ju-Fang Shi
- Authors' Affiliations: Departments of Cancer Epidemiology
| | | | | | - Shu-Min Li
- Gynecology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - You-Lin Qiao
- Authors' Affiliations: Departments of Cancer Epidemiology,
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