Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Obstet Gynecol Surv. 2012 Oct;67(10):658-67. doi: 10.1097/OGX.0b013e3182732375.
The implementation of cytology-based screening programs for precancerous lesions of the cervix has decreased the incidence of and mortality from cervical cancer in much of the developed world. Countries without the resources to install such frequent and laboratory-dependent screening programs have more and more options at their disposal. A screening program based on cytology analysis requires too much training, infrastructure, and repeated screening to be feasible. Visual inspection with acetic acid, often used throughout the world, is inexpensive and both sensitive and specific, but it lacks reproducibility. Although human papillomavirus (HPV) testing is too expensive for widespread use, its negative predictive value and sensitivity make it a promising method of screening. Utilizing HPV vaccines as a primary mode of prevention may not be financially feasible and does not obviate the need for screening. Cervical cancer has been considered an AIDS-defining illness, with HPV and HIV often coexisting, and screening methods have been shown to be as reliable for women with HIV as those without. Ultimately, the most clinically effective and cost-effective methods for reducing cervical cancer incidence are those that limit the number of visits that women are required to attend. Providing immediate cryotherapy for those with a positive screen, whether by visual inspection or HPV testing, is promising to have quite an impact, although the type of program implemented will depend on the needs and expectations of each country.
基于细胞学的宫颈癌前病变筛查方案的实施，已经降低了许多发达国家宫颈癌的发病率和死亡率。那些没有资源建立这种频繁且依赖实验室的筛查方案的国家，越来越多地拥有了可供选择的方案。基于细胞学分析的筛查方案需要大量的培训、基础设施和重复筛查，因此不可行。在世界范围内广泛使用的醋酸视觉检查虽然价格低廉，且具有敏感性和特异性，但缺乏可重复性。虽然人乳头瘤病毒（HPV）检测费用过高，无法广泛应用，但它的阴性预测值和敏感性使其成为一种有前途的筛查方法。利用 HPV 疫苗作为主要的预防手段可能在经济上不可行，并且不能免除筛查的需要。宫颈癌一直被认为是艾滋病的一种定义性疾病，HPV 和 HIV 常常同时存在，而且已经证明，筛查方法对于 HIV 阳性和阴性的女性都是可靠的。最终，减少宫颈癌发病率最具临床有效性和成本效益的方法是限制女性需要接受的就诊次数。对于那些筛查结果阳性的女性，无论是通过醋酸视觉检查还是 HPV 检测，立即进行冷冻治疗都具有很大的潜力，尽管实施的方案类型将取决于每个国家的需求和期望。
