Sasieni P D
Department of Mathematics, Statistics and Epidemiology, Imperial Cancer Research Fund, London.
J Am Med Womens Assoc (1972). 2000 Summer;55(4):216-9.
Infection with one of several types of human papillomavirus (HPV) appears to be a necessary first step in the development of invasive cervical cancer. We cannot currently treat HPV infections; thus, the role of HPV testing is to identify women with precancerous lesions that can be removed and, in so doing, prevent progression to invasive carcinoma. Although HPV testing may help to identify women at risk of cervical cancer who might be missed by other screening tests, it is inherently nonspecific at identifying those who would otherwise develop cervical cancer. In order to avoid overtreatment of women with minor lesions with little potential for progression, HPV testing needs to be repeated or combined with Pap smears. Protocols for HPV screening have yet to be properly evaluated. Here we consider several possible applications of HPV testing in the prevention of cervical cancer. The most immediate role is as a secondary test in women with minor cytological abnormalities. Appropriate use of HPV testing as a primary screening tool depends on the setting. In a developed country without an organized screening program, HPV testing might be used in addition to Pap smears in women age 35 and over to increase sensitivity. Within an organized screening program, HPV testing might be used in combination with Pap testing, but with extended screening intervals so as to obtain the maximum advantage to women without unduly increasing costs. Where resources are strictly limited, an attractive option would be to perform visual inspection of the cervix after application of dilute acetic acid using a low threshold for referral, and to test for HPV only on those with abnormal looking lesions.
感染几种人乳头瘤病毒（HPV）中的一种似乎是浸润性宫颈癌发生的必要第一步。目前我们无法治疗HPV感染；因此，HPV检测的作用是识别可切除的癌前病变女性，从而预防进展为浸润性癌。尽管HPV检测可能有助于识别其他筛查检测可能遗漏的宫颈癌高危女性，但在识别那些否则会发展为宫颈癌的女性方面，其本质上是非特异性的。为了避免对进展可能性小的轻度病变女性进行过度治疗，HPV检测需要重复进行或与巴氏涂片联合使用。HPV筛查方案尚未得到恰当评估。在此我们考虑HPV检测在预防宫颈癌方面的几种可能应用。最直接的作用是作为细胞学轻度异常女性的二次检测。HPV检测作为主要筛查工具的恰当使用取决于具体情况。在没有有组织筛查项目的发达国家，35岁及以上女性除巴氏涂片外可能还会使用HPV检测以提高敏感性。在有组织的筛查项目中，HPV检测可能与巴氏检测联合使用，但延长筛查间隔，以便在不过度增加成本的情况下为女性带来最大益处。在资源严格受限的地方，一个有吸引力的选择是在应用稀醋酸后对宫颈进行目视检查，并采用低转诊阈值，仅对外观异常的病变进行HPV检测。
