Obstetrics/GynecologyORIGINAL ARTICLE

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

Daniel Martingano, DO; Audrey Renson, BS; Alison Jane Martingano, BSc (hons), MA; and Francis X. Martingano, MD
Notes and Affiliations
Notes and Affiliations

Received: June 23, 2017

Accepted: August 17, 2017

Published: January 1, 2018

From the Department of Obstetrics and Gynecology at the New York University School of Medicine in New York (Drs D. Martingano and F.X. Martingano); the Department of Clinical Research and Statistics at the New York University Langone Hospital–Brooklyn in Brooklyn (Ms Renson); the Department of Psychology at The New School for Social Research in New York, New York (Ms Martingano); and the Department of Biomedical Informatics at Rutgers University School of Health Professions in Newark, New Jersey (Dr D. Martingano).

J Osteopath Med; 118(1): 8-18

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.

Objectives: To compare the differences in progression and regression of precancerous lesions of the uterine cervix on cervical cytologic analysis among women of different races 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 for Colposcopy and Cervical Pathology guidelines. The authors fit Markov multistate models to 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 model using a likelihood ratio test.

Results: The sample included 5472 women receiving a Papanicolaou test between January 2006 and September 2016, contributing a total of 24,316 person-years of follow-up. Of 21 hazard 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), and high-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 had a slower rate of progression from ASC-US to LSIL, with Hispanics having demonstrated the slowest rate from ASC-US to LSIL. Hispanics also demonstrated the fastest rate from LSIL to HSIL when compared with all other race categories. In regressions, blacks had the slowest rate of regression from HSIL to LSIL, and Asians had the fastest rate from LSIL to ASC-US. The Hispanic group demonstrated the fastest expected progression (17.6 years; 95% CI, 11.5-25.5), as well as the fastest regression (27.6 years; 95% CI, 21.5-35.6), and the black group has the slowest expected times for both progression (28.1 years; 95% CI, 14.6-47.2) and regression (49 years; 95% CI, 29.1-86.2). The number of visits (1 vs ≥2) in the study was differentially distributed both by race (P=.033) and by last diagnosis (P<.001).

Conclusions: Variations in precancerous lesions of the uterine cervix are not uniform across races.

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