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Sholom Wacholder, Clinical Utility in Evaluation of Risk Models, American Journal of Epidemiology, Volume 176, Issue 6, 15 September 2012, Pages 495–496, https://doi.org/10.1093/aje/kws255
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Extract
Statistical and clinical perspectives on risk models can be very different, even with agreement on the objective: to develop accurate and precise risk estimates for rational, effective, and cost-effective prevention strategies (1). For example, Katki et al. (2) estimated the risk of cervical precancer (cervical intraepithelial neoplasia grade 3) or worse conditional on results of concurrent testing for human papillomavirus (HPV) and cervical cytology (cotesting) in 300,000 women 30 years of age or older who were enrolled in a large health maintenance organization. The nearly equivalent risk over 5 years for all the women who were HPV negative (3.8 per 100,000 per year) and those who were both HPV negative and cytology negative (3.2 per 100,000 per year) might justify a prevention program using primary screening based on results of HPV testing alone. In contrast, among 17,000 HPV-positive women, the 5-year risk of cervical intraepithelial neoplasia grade 3 or worse was substantially lower (5.9%) in the 12,000 women with normal cytology than it was in the 5,000 women who had abnormal cytology (12.1%). This suggests that cytology testing might improve decisions about management of women who test positive for HPV.
