Sriamporn Supannee, Khuhaprema Thiravud, Parkin Max
Department of Epidemiology, Faculty of Public Health, Khon Kaen University, Thailand.
J Med Screen. 2006;13 Suppl 1:S39-43.
In Thailand, there have been no 'organized' programmes of screening for cervical cancer. For the most part, screening has been unsystematic or provided to women 'on demand'. In 2002, the Department of Medical Services of the Ministry of Public Health proposed the screening of the entire population of women in Thailand at 5-yearly intervals from the ages of 35 to 60 years. As a first step, measures to increase the capacity for obtaining and interpreting papanicolaou (Pap) smears have been put in place. Research studies have examined the effectiveness of screening with Pap smears in Thailand, and confirmed that, as elsewhere, protection is related to the number of previous tests and the time elapsed since the most recent one. Coverage of the population remains low. Other methods of screening are being investigated in Thailand, including visual inspection following acetic acid (VIA), followed by immediate treatment of observed lesions by cryotherapy ('see and treat'). Other research studies have examined the acceptability and performance of self-sampling as a means of obtaining Pap smears, and the use of mobile clinics to increase coverage of at-risk women in rural settings. Human papillomavirus (HPV) testing has been used to identify high-risk women, or to help decide which women with low-grade abnormality on cytology should undergo more intensive follow-up. Prevalence of HPV in normal women in Thailand is 9-20%, but HPV testing has not been used on any systematic basis to date. Current screening programmes in Thailand are not very effective. The national cancer control programme aims to increase the coverage of screening. The population-based cancer registry will provide an effective and economical method of evaluating the impact of early diagnosis and screening at community level.
在泰国，尚未开展“有组织”的宫颈癌筛查项目。在很大程度上，筛查工作缺乏系统性，或是应女性“要求”提供。2002年，泰国公共卫生部医疗服务司提议，对35至60岁的泰国女性全体每5年进行一次筛查。作为第一步，已采取措施提高获取和解读巴氏涂片的能力。研究探讨了在泰国进行巴氏涂片筛查的有效性，并证实，与其他地方一样，保护作用与既往检查次数以及距最近一次检查的时间有关。人群覆盖率仍然很低。泰国正在研究其他筛查方法，包括醋酸染色肉眼观察法（VIA），随后对观察到的病变立即采用冷冻疗法进行治疗（“即看即治”）。其他研究探讨了自我采样作为获取巴氏涂片的一种方式的可接受性和效果，以及利用流动诊所提高农村地区高危女性的覆盖率。人乳头瘤病毒（HPV）检测已用于识别高危女性，或帮助确定哪些细胞学检查结果为低度异常的女性应接受更密切的随访。泰国正常女性中HPV的患病率为9%至20%，但迄今为止，HPV检测尚未在任何系统基础上使用。泰国目前的筛查项目效果不太理想。国家癌症控制项目旨在提高筛查覆盖率。基于人群的癌症登记将提供一种有效且经济的方法，用于评估社区层面早期诊断和筛查的影响。
