Skjeldestad Finn Egil, Hagen Bjørn, Hagmar Bjørn, Iversen Ole-Erik, Juvkam Kari Hilde, Steen Rita, Thoresen Steinar, Hareide Bodolf
Avdeling for epidemiologi, SINTEF Helse og Institutt for laboratoriemedisin, barne- og kvinnesykdommer, Norges teknisk-naturvitenskapelige universitet, 7465 Trondheim.
Tidsskr Nor Laegeforen. 2007 Jun 28;127(13):1782-5.
The Norwegian coordinated cervical cancer screening program invites women from 25 to 69 years of age to have a cytological smear from the cervix uteri analysed every third year. The aim of this study was to identify the volume of smears collected and to evaluate the consequences of having or not having this done for 24-year-old and younger women not included in the screening program and to compare the results with those for other age groups.
Data were obtained from the following Norwegian Cancer Registry sources: the Cancer Registry for incident cases of cancer cervix uteri (1995-2004), the Cytology Registry for volume of cervical specimen collection (1992-2005) and outcome of smears (2004), the CIN-treatment database for the number of incident cases of cervical intraepithelial neoplasia grade 2 or 3 (2004) and the Cervix Histology Registry for histological outcome of cervical biopsies (2004). Data were displayed by age (< or = 24, 25-29, 30-69 and 70 years or older). No statistical testing was done.
Cancer in the cervix uteri is extremely rare among 24 year-old and younger women (0-3 cases per year). The volume of cervix smears taken from young women has decreased over the past 10 years; in 2005 approximately 35,000 out of 440,000 smears came from young women. More smears from young women were inconclusive and more lesions were of low grade than in older women; repeat testing was therefore required more frequently in young women. More young than older women were diagnosed with grade 1 or grade 2 lesions.
Most lesions in young women regress spontaneously. By not collecting smears from young women, many lesions that would anyway regress spontaneously, would not be discovered and follow-up could be avoided. Prospective follow-up studies of viral processes and oncogeneses indicate that it takes many years for normal cervix cells in the uterus to develop into cancer. For most young women it makes no difference whether low grade lesions or lesions that require treatment are diagnosed at age 23, 24 or shortly after 25. With reference to data from the Norwegian Cancer Registry and international literature, we conclude that analysis of cytological cervix smears from young women is more harmful than beneficial.
挪威宫颈癌联合筛查项目邀请25至69岁的女性每三年进行一次子宫颈细胞学涂片检查。本研究的目的是确定所采集涂片的数量，并评估对未纳入筛查项目的24岁及以下女性进行或不进行该项检查的后果，并将结果与其他年龄组进行比较。
数据来自挪威癌症登记处的以下来源：子宫颈癌发病病例癌症登记处（1995 - 2004年）、子宫颈标本采集量细胞学登记处（1992 - 2005年）及涂片结果（2004年）、宫颈上皮内瘤变2级或3级发病病例数量的CIN治疗数据库（2004年）以及宫颈活检组织学结果的宫颈组织学登记处（2004年）。数据按年龄（≤24岁、25 - 29岁、30 - 69岁和70岁及以上）展示。未进行统计学检验。
子宫颈癌在24岁及以下女性中极为罕见（每年0至3例）。过去10年中，从年轻女性采集的子宫颈涂片数量有所减少；2005年，在44万份涂片中，约3.5万份来自年轻女性。与老年女性相比，年轻女性的涂片更多结果不明确，且更多病变为低级别；因此年轻女性需要更频繁地进行重复检测。被诊断为1级或2级病变的年轻女性多于老年女性。
年轻女性的大多数病变会自然消退。不采集年轻女性的涂片，许多无论如何都会自然消退的病变将不会被发现，从而可避免后续跟进。对病毒过程和肿瘤发生的前瞻性随访研究表明，子宫内正常宫颈细胞发展成癌症需要很多年。对于大多数年轻女性而言，在23岁、24岁或25岁刚过不久时被诊断出低级别病变或需要治疗的病变并无差异。参考挪威癌症登记处的数据和国际文献，我们得出结论，对年轻女性进行子宫颈细胞学涂片分析弊大于利。
