Belinson Jerome L, Pretorius Robert G, Enerson Christine, Garcia Francisco, Cruz Eduardo Pérez, Belinson Suzanne E, Yeverino García Eduardo, Brainard Jennifer
Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA.
Int J Gynecol Cancer. 2009 Jan;19(1):27-32. doi: 10.1111/IGC.0b013e318197f479.
The Mexican Cervical Cancer Screening (MECCS) study took place in the State of Michoacán. Primary screening was by self-sampling for high-risk human papillomavirus (HR-HPV). The objectives were to increase the specificity of primary HPV screening by requiring 2 positive HPV tests 1 year apart in women whose secondary screen was negative according to an acetic acid-aided visual inspection (VIA). In addition, we postulated that the sensitivity of VIA would be sufficient to identify large preinvasive lesions and cancers unsuitable for cryotherapy if applied in a see-and-treat algorithm.A total of 8621 women (aged 30-50 years) were screened, and 14.3% were positive for HR-HPV. In phase 1, 11.9% of the HPV-positive women were VIA-positive and were referred for colposcopy with directed and random biopsies. If VIA-negative, women repeated the self-sample 1 year later to detect persistent HR-HPV (25.2% were positive). If persistently HR-HPV-positive in phase 2, patients again had VIA, then all women (both VIA-positive and -negative) received directed and random biopsies. If cryotherapy had been used to treat HPV- and VIA-positive women in phase 1 or persistent HR-HPV-positive (phase 2), the potential risk of undertreatment would have been 4.1%, and 66.4% of the treated patients would have had normal or cervical intraepithelial neoplasia I on biopsy. The VIA triage would refer 0.73% of the patients to colposcopy owing to the lesion size, location, or the presence of a cancer. On the basis of this pilot study, we are encouraged to explore and evaluate a rapid, more sensitive, and more specific self-test.
墨西哥宫颈癌筛查（MECCS）研究在米却肯州开展。初次筛查采用高危型人乳头瘤病毒（HR-HPV）自我采样法。其目标是，对于根据醋酸辅助肉眼检查（VIA）二次筛查为阴性的女性，要求间隔1年进行2次HPV检测呈阳性，以提高初次HPV筛查的特异性。此外，我们推测，如果采用即查即治算法，VIA的敏感性足以识别出不适用于冷冻治疗的大型癌前病变和癌症。共有8621名年龄在30至50岁之间的女性接受了筛查，14.3%的女性HR-HPV检测呈阳性。在第1阶段，11.9%的HPV阳性女性VIA检测呈阳性，并被转诊接受阴道镜检查及定向活检和随机活检。如果VIA检测为阴性，女性在1年后重复自我采样，以检测持续性HR-HPV（25.2%呈阳性）。如果在第2阶段持续HR-HPV阳性，患者再次进行VIA检测，然后所有女性（VIA检测阳性和阴性）均接受定向活检和随机活检。如果在第1阶段对HPV和VIA检测呈阳性的女性或持续性HR-HPV阳性（第2阶段）的女性使用冷冻疗法进行治疗，潜在的治疗不足风险将为4.1%，且66.4%的接受治疗的患者活检结果将显示正常或为宫颈上皮内瘤变I级。由于病变大小、位置或癌症的存在，VIA分流将把0.73%的患者转诊至阴道镜检查。基于这项初步研究，我们受到鼓舞，去探索和评估一种快速、更敏感且更具特异性的自我检测方法。
