The natural history of cervical cancer in chinese women: results from an 11-year follow-up study in china using a multistate model.
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.


CONCLUSIONS
This study may serve as a valuable reference to future research on other multistate cancer processes.
Authors' Affiliations: Departments of Cancer Epidemiology.
Shao-Kai
SK
Zhang
Authors' Affiliations: Departments of Cancer Epidemiology.
Le-Ni
LN
Kang
Authors' Affiliations: Departments of Cancer Epidemiology, Miller School of Medicine, University of Miami, Miami, Florida.
Irene J
IJ
Chang
Authors' Affiliations: Departments of Cancer Epidemiology.
Fang-Hui
FH
Zhao
Authors' Affiliations: Departments of Cancer Epidemiology.
Shang-Ying
SY
Hu
Authors' Affiliations: Departments of Cancer Epidemiology.
Wen
W
Chen
Authors' Affiliations: Departments of Cancer Epidemiology.
Ju-Fang
JF
Shi
Pathology, and.
Xun
X
Zhang
Pathology, and.
Qin-Jing
QJ
Pan
Gynecology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and.
Shu-Min
SM
Li
Authors' Affiliations: Departments of Cancer Epidemiology, qiaoy@cicams.ac.cn.
You-Lin
YL
Qiao
D000328:Adult; D044466:Asian People; D002681:China; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D009365:Neoplasm Regression, Spontaneous / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D002578:Uterine Cervical Dysplasia / Q000473:pathology*