Variations in Progression and Regression of Precancerous Lesions of the Uterine Cervix on Cytology Testing Among Women of Different Races

摘要

Background: Although not incorporated into current cervical cancer screening guidelines,racial differences are known to persist in both occurrence of and outcomes related to cervical cancer.Objective: To compare the differences in progression and regression of precancerouslesions of the uterine cervix on cervical cytologic analysis among women of differentraces who adhered to cervical cancer screening recommendations and follow-up.Methods: Retrospective cohort study comparing differences in precancerous lesion diagnoses for patients receiving adequate evaluation according to the American Society forColposcopy and Cervical Pathology guidelines. The authors fit Markov multistate modelsto estimate self-reported race-specific expected wait times and hazard ratios for each possible regression and progression and compared a race model with an intercept-only modelusing a likelihood ratio test.Results: The sample included 5472 women receiving a Papanicolaou test between January2006 and September 2016, contributing a total of 24,316 person-years of follow-up. Of 21hazard ratios tested for significance, the following 4 hazard ratios (95% CIs) were statistically significant: atypical squamous cells of undetermined significance (ASC-US) progression to low-grade squamous intraepithelial lesion (LSIL) for Hispanic patients (0.72; 95%CI, 0.54-0.96); LSIL regression to ASC-US for Hispanic patients (1.55; 95% CI, 1.04-2.31), LSIL regression to ASC-US for Asian patients (1.91; 95% CI, 1.08-3.36), andhigh-grade squamous intraepithelial lesion regression to LSIL for black patients (0.39;95% CI, 0.16-0.96). There is an observed trend that all racial groups other than white hada slower rate of progression from ASC-US to LSIL, with Hispanics having demonstratedthe slowest rate from ASC-US to LSIL. Hispanics also demonstrated the fastest rate fromLSIL to HSIL when compared with all other race categories. In regressions, blacks hadthe slowest rate of regression from HSIL to LSIL, and Asians had the fastest rate fromLSIL to ASC-US. The Hispanic group demonstrated the fastest expected progression(17.6 months; 95% CI, 11.5-25.5), as well as the fastest regression (27.6 months; 95% CI,21.5-35.6), and the black group has the slowest expected times for both progression (28.1months; 95% CI, 14.6-47.2) and regression (49 months; 95% CI, 29.1-86.2). The numberof visits (1 vs ≥2) in the study was differentially distributed both by race (P=.033) and bylast diagnosis (P<.001).Conclusion: Variations in precancerous lesions of the uterine cervix are not uniform acrossraces.