Suba Eric J, Donnelly Amber D, Furia Lisa M, Huynh My Linh D, Raab Stephen S
Kaiser Permanente Medical Center, South San Francisco, CA 94080, USA.
Diagn Cytopathol. 2007 Mar;35(3):187-91. doi: 10.1002/dc.20575.
The debate over the best route for cervical cancer prevention in developing countries may be considered part of a larger debate over whether the global health community has become enamored with the promise of new approaches at the expense of delivering available preventives today. Pap screening, which is feasible anywhere cervical screening is appropriate, is the only intervention currently available for the prevention of cervical cancer in developing countries, and the Pap test will be an essential component of future novel preventive approaches. Cervical cancer vaccination, the long-term effectiveness of which is uncertain, will not eliminate screening requirements and is currently not affordable in developing countries. Root cause analyses, which may appropriately inform the best routes for improving health in developing countries, document that failures of cervical cancer prevention efforts are not attributable to factors specific to the Pap test but to lapses in programmatic quality management to which all screening tests are vulnerable. The genuine promise of cervical cancer prevention for all the world's women therefore resides in skilled quality management rather than novel screening approaches. We propose a global consensus policy by which Pap screening services will be provided in any setting where cervical screening is appropriate but unavailable, with consideration given to novel preventive approaches as they mature. Opportunity costs, borne by the underserved, are associated with prioritizing research on new approaches in any setting where established preventives are feasible but unavailable.
关于发展中国家预防宫颈癌的最佳途径的争论，可能被视为一场更大争论的一部分，这场争论是：全球卫生界是否痴迷于新方法的前景，而牺牲了当下提供现有的预防措施。巴氏涂片筛查在任何适合进行宫颈筛查的地方都是可行的，是目前发展中国家预防宫颈癌唯一可用的干预措施，并且巴氏试验将是未来新型预防方法的重要组成部分。宫颈癌疫苗接种的长期效果尚不确定，不会消除筛查需求，而且目前在发展中国家无法负担得起。根本原因分析可能会为改善发展中国家健康状况的最佳途径提供适当信息，其表明宫颈癌预防工作的失败并非归因于巴氏试验特有的因素，而是归因于所有筛查试验都易出现的项目质量管理失误。因此，为全世界女性预防宫颈癌的真正希望在于熟练的质量管理，而非新型筛查方法。我们提议一项全球共识政策，即在任何适合进行宫颈筛查但尚未开展的地方提供巴氏涂片筛查服务，并在新型预防方法成熟时加以考虑。在任何已有预防措施可行但未得到实施的情况下，将资源优先用于研究新方法会给服务不足人群带来机会成本。
