Natural history of cervical intraepithelial neoplasia: a meta-analysis.
OBJECTIVE
To determine the probabilities of transition of stages in the cervical cancer by conducting a meta-studies on the topic.


METHODS
We identified health states of interest in the natural history of cervical precancer, identified all possible papers that could meet selection criteria, developed relevance and acceptability criteria for inclusion, then thoroughly reviewed the selected studies. To determine the transition probability data we used a random effects model. We determined probabilities for 4 health state transitions. The 6-month mean predictive transition probability (95% confidence intervals with "prediction interval" in parentheses) for high grade squamous intraepithelial lesions (HSIL) to cancer was 0.0037 (0.00004, 0.03386), for low grade squamous intraepithelial lesions (LSIL) to HSIL was 0.0362 (0.00055, 0.23220), for HSIL to LSIL was 0.0282 (0.00027, 0.35782), and for LSIL to normal was 0.0740 (0.00119, 0.42672).


CONCLUSIONS
The transition probabilities between cervical cancer health states for 6-month intervals are small; however, the cumulative risk of cervical cancer is significant. Markers to identify the cervical precursors that will lead to the transition to cervical cancer are needed.
Cantor
Scott B
SB
Department of Biostatistics and Applied Mathematics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas77030-4009, USA. sbcantor@mdanderson.org
Atkinson
E Neely
EN
Cardenas-Turanzas
Marylou
M
Benedet
J L
JL
Follen
Michele
M
MacAulay
Calum
C
D016001:Confidence Intervals; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000473:pathology*; D011336:Probability; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology*