Braun Stephan, Reimer Daniel, Strobl Isolde, Wieland Ulrike, Wiesbauer Petra, Müller-Holzner Elisabeth, Fessler Siegfried, Scherer Arthur, Marth Christian, Zeimet Alain G
Department of Obstetrics and Gynecology, Innsbruck Medical University, Anichstrasse 35, AT-6020 Innsbruck, Austria.
J Med Case Rep. 2011 Jul 18;5:316. doi: 10.1186/1752-1947-5-316.
Well-documented cases of untreated cervical intra-epithelial dysplasia resulting in fatal progression of invasive cervical cancer are scarce because of a long pre-invasive state, the availability of cervical cytology screening programs, and the efficacy of the treatment of both pre-invasive and early-stage invasive lesions.
We present a well-documented case of a 29-year-old Caucasian woman who was found, through routine conventional cervical cytology screening, to have pathologic Papanicolaou (Pap) grade III D lesions (squamous cell abnormalities). She subsequently died as a result of human papillomavirus type 18-associated cervical cancer after she refused all recommended curative therapeutic procedures over a period of 13 years.
This case clearly demonstrates a caveat against the promotion and use of complementary alternative medicine as pseudo-immunologic approaches outside evidence-based medicine paths. It also demonstrates the impact of the individualized demands in diagnosis, treatment and palliative care of patients with advanced cancer express their will to refuse evidence-based treatment recommendations.
由于存在较长的癌前状态、宫颈细胞学筛查项目的可及性以及对癌前病变和早期浸润性病变治疗的有效性，未经治疗的宫颈上皮内瘤变导致浸润性宫颈癌致命进展的充分记录病例很少见。
我们报告一例有充分记录的病例，一名29岁的白人女性，通过常规宫颈细胞学筛查发现有病理巴氏（Pap）III D级病变（鳞状细胞异常）。在13年的时间里，她拒绝了所有推荐的根治性治疗程序，随后因18型人乳头瘤病毒相关的宫颈癌死亡。
该病例清楚地表明了在循证医学路径之外推广和使用补充替代医学作为伪免疫方法的一个警示。它还表明了晚期癌症患者在诊断、治疗和姑息治疗中个性化需求的影响，这些患者表达了拒绝循证治疗建议的意愿。
