| Titre : | Modeling the time dependence of the association between human papillomavirus infection and cervical cancer precursor lesions. (2003) |
| Auteurs : | Nicolas-F SCHLECHT ; Eliane DUARTE-FRANCO ; Alex FERENCZY ; Eduardo-L FRANCO ; Abdissa NEGASSA ; Robert-W PLATT ; Thomas-E ROHAN ; Luisa-L VILLA ; Albert Einstein College of Medicine. Department of Epidemiology and Population Health. New York. NY. USA ; McGill University. Faculty of Medicine. Department of Epidemiology and Biostatistics. Montreal. PQ. CAN ; McGill University. Faculty of Medicine. Department of Oncology. Montreal. PQ. CAN |
| Type de document : | Article |
| Dans : | American journal of epidemiology (vol. 158, n° 9, 2003) |
| Pagination : | 878-886 |
| Langues: | Anglais |
| Mots-clés : | Cancer ; Homme ; Femme ; Virus ; Virose ; Infection ; Epidémiologie |
| Résumé : | [BDSP. Notice produite par INIST-CNRS bw0VR0xq. Diffusion soumise à autorisation]. The authors studied the time-dependent association between human papillomavirus (HPV) infection and squamous intraepithelial lesions (SIL) among women enrolled in a cohort study in Brazil (1993-2002), using repeated Papanicolaou cytologic examination and HPV testing by polymerase chain reaction. Through simulation with conceivable alternative cohort designs, they investigated different regression modeling approaches using time-varying covariates, time-varying hazard ratio functions, and repeated events to assess the effect of delay in lesion detection. Associations between HPV and early SIL were of high magnitude. The age-adjusted hazard ratios for the association between HPV at enrollment and low-grade SIL decreased gradually with time until 72 months for both oncogenic types of HPV (hazard ratio=3.96,95% confidence interval (Cl) : 2.5,6.4) and non oncogenic types (hazard ratio=2.37,95% CI : 1.3,4.3). The hazard ratio for incident high-grade SIL remained constant, ranging from 7.15 (95% Cl : 2.0,25.1) at 12 months to 6.26 (95% Cl : 2.7,14.5) at 72 months for oncogenic types of HPV. With oncogenic HPV as the time-dependent predictor variable, the hazard ratios for incident SIL and high-grade SIL events were 14.2 (95% CI : 8.7,23.1) and 32.7 (95% CI : 8.4,127.3), respectively. Investigators may underestimate the prognostic value of HPV detection using designs that rely on HPV ascertainment at a single time point. The waning in hazard ratios should be considered in the implementation of HPV testing-based screening programs. |
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