Sharma A, Menon U
Department of Gynaecological Oncology, Institute of Women's Health, University College London, 149, Tottenham Court Road, London W1T 7DN, UK.
Eur J Surg Oncol. 2006 Oct;32(8):818-24. doi: 10.1016/j.ejso.2006.03.034. Epub 2006 May 8.
The role of screening in gynaecological cancers is under evaluation. With mass screening proven effective in significantly reducing cervical cancer mortality, there is an interest in developing other screening methods to detect gynaecological malignancies early. This review covers advances in cervical cancer screening, strategies being investigated in ovarian cancer screening and the lack of justification in screening for endometrial, vulval and vaginal cancers.
A Medline based literature search was performed for articles relating to screening for different gynaecological malignancies. Additional original papers cited in those identified by the initial search were also reviewed.
Advances in cervical cancer screening include liquid-based cytology and HPV testing. Results of ongoing trials are awaited before these can be fully implemented. The results of the two large, multicentre, randomised controlled trials being conducted in the United Kingdom and United States (UKCTOCS and PLCO study, respectively) to assess impact of screening on ovarian cancer mortality will shed some light on the need to implement screening for ovarian cancer in the general population. Novel markers, serum proteomic profiles and Doppler are some of the other technologies being explored. Currently, screening for endometrial cancer is not advocated as most women present with symptoms in early disease with good survival outcomes. Vulval and vaginal cancers are too rare to justify mass screening.
Methods to screen for various gynaecological malignancies need further evaluation before implementation in the general population. Results of large multicentred trials are awaited. Presently, screening for endometrial, vaginal and vulval cancers is not justified.
筛查在妇科癌症中的作用正在评估中。鉴于大规模筛查已被证明能有效显著降低宫颈癌死亡率，人们对开发其他筛查方法以早期发现妇科恶性肿瘤产生了兴趣。本综述涵盖了宫颈癌筛查的进展、卵巢癌筛查中正在研究的策略以及子宫内膜癌、外阴癌和阴道癌筛查缺乏依据的情况。
基于Medline进行文献检索，查找与不同妇科恶性肿瘤筛查相关的文章。对初始检索所识别文章中引用的其他原始论文也进行了综述。
宫颈癌筛查的进展包括液基细胞学和人乳头瘤病毒（HPV）检测。在这些方法能够全面实施之前，还需等待正在进行的试验结果。英国和美国分别开展的两项大型多中心随机对照试验（分别为UKCTOCS和PLCO研究）旨在评估筛查对卵巢癌死亡率的影响，其结果将为普通人群中实施卵巢癌筛查的必要性提供一些线索。其他正在探索的技术包括新型标志物、血清蛋白质组图谱和多普勒检查。目前，不提倡对子宫内膜癌进行筛查，因为大多数女性在疾病早期出现症状，且生存结局良好。外阴癌和阴道癌过于罕见，不值得进行大规模筛查。
在普通人群中实施各种妇科恶性肿瘤筛查方法之前，需要进一步评估。有待大型多中心试验的结果。目前，对子宫内膜癌、阴道癌和外阴癌进行筛查是不合理的。
