Suba Eric J, Donnelly Amber D, Furia Lisa M, Huynh My Linh D, Raab Stephen S
Department of Pathology, Kaiser Permanente Medical Center, South San Francisco, California 94080, USA.
Diagn Cytopathol. 2005 Nov;33(5):344-51. doi: 10.1002/dc.20284.
The Viet/American Cervical Cancer Prevention Project embraces a dual mission. We seek to develop sustainable, cost-effective cervical cancer prevention services for women in Vietnam. Because the problem of cervical cancer in Vietnam is in part a legacy of the Second Indochinese War, we also seek to examine obstacles to reconciliation by presenting what most acknowledge to be a remedy in advance of what some will perceive to be an accusation. Certain research and commercial interests have produced obstacles to our dual mission in Vietnam. The Alliance for Cervical Cancer Prevention, supported by the Bill and Melinda Gates Foundation, has failed to endorse Pap screening for developing countries and is conducting clinical trials which may further disaffect medically underserved groups. Visual screening techniques combined with immediate ablative treatment methods are incompatible with the requirements of "first do no harm." Because the Pap smear will probably be a component of any future human papillomavirus (HPV)-based or visual- based screening programs, it serves the interests of those promoting noncytologic screening methods to also support the development of Pap screening services. Research on HPV screening in developing countries raises concerns of commercial exploitation. Because Pap screening is feasible wherever cervical screening is appropriate, it is inappropriate to delay the development of Pap screening services pending research into HPV vaccines or alternative screening technologies. Quality management is the point at which public health and diagnostic pathology intersect and will remain an indispensable element of cervical screening programs irrespective of the screening test(s) eventually used. Pap screening in developing countries is an ethical imperative without a substantial political constituency and will benefit from the engagement of organized cytology.
越南/美国宫颈癌预防项目肩负着双重使命。我们致力于为越南女性开发可持续、具成本效益的宫颈癌预防服务。鉴于越南的宫颈癌问题部分源于第二次印度支那战争，我们还试图通过在一些人可能视为指责之前提出多数人认可的补救办法，来审视和解的障碍。某些研究和商业利益给我们在越南的双重使命带来了障碍。由比尔及梅琳达·盖茨基金会支持的宫颈癌预防联盟未能认可在发展中国家开展巴氏涂片筛查，且正在进行临床试验，这可能会进一步疏远医疗服务不足的群体。视觉筛查技术与即时消融治疗方法不符合“首先不造成伤害”的要求。由于巴氏涂片检查可能会成为未来任何基于人乳头瘤病毒（HPV）或基于视觉的筛查项目的一部分，支持非细胞学筛查方法的人也应支持巴氏涂片筛查服务的发展，这符合他们的利益。在发展中国家开展HPV筛查的研究引发了对商业剥削的担忧。鉴于只要适合进行宫颈筛查，巴氏涂片检查就是可行的，因此在等待HPV疫苗或替代筛查技术的研究结果时推迟巴氏涂片筛查服务的发展是不合适的。质量管理是公共卫生与诊断病理学的交叉点，无论最终使用何种筛查测试，质量管理都将始终是宫颈筛查项目不可或缺的要素。在发展中国家开展巴氏涂片筛查是一项道德要求，但缺乏强大的政治支持群体，而有组织的细胞学参与将使其受益。
