Department of Obstetrics and Gynaecology, The Princess Royal University Hospital/South London Healthcare NHS Trust, Farnborough Common, Orpington, Kent BR6 8ND, UK.
Arch Gynecol Obstet. 2013 Apr;287(4):765-9. doi: 10.1007/s00404-012-2631-9. Epub 2012 Nov 25.
Since 2003, when the age threshold of cervical screening in England has been raised from 20 to 25, there have been many calls to restore the previous starting age for cervical screening as there are concerns about the delaying of initiating cervical screening may result in an increase in the risk of cervical cancer. We conducted a retrospective study to analyse the safety of changing the starting age of cervical screening programme in England to the age of 25, by reviewing the cervical cytology performed in 426 women under 25 years in Bromley Borough of London, UK, between 2005 and 2009.
We conducted a retrospective analysis of 426 women under 25 years, who were referred with cervical smears taken at Bromley PCT's to the colposcopy clinic at Bromley Hospitals, South London Healthcare NHS Trust, over a 4-year period, between 2005 and 2009. The colposcopy findings and histology results were reviewed and analysed.
In our review, 44.80 % of smears showed mild dyskaryosis. 23 and 12 % showed moderate dyskaryosis and severe dyskaryosis, respectively. 11.2 % had borderline smear, and 0.2 % revealed glandular changes. On colposcopic examination, only 16.2 % (69) were reported as normal; however, 25.8, 20 % of the women were diagnosed with low and high grade abnormalities, respectively. 12 % (53) of the cases showed HPV-related changes, whereas no suspected malignancy was found. Colposcopic-directed cervical biopsy was obtained in 228 women (~54 %) depending on the colposcopic examination findings. The most histological finding was CIN I which constitutes 48 % (110) of all biopsies. However, 25 % (58) and 9 % (20) revealed CIN II and CIN III, respectively. The glandular changes noticed in only one case (0.44 %). The treatment was planned for 130 women, a significant proportion (30.5 %) of the 426 women who referred for colposcopy. The histological examination of the biopsies showed CIN in 91 % of the cases (115), 74.8 % (86) of them had CIN II (36) or CIN III (50). In addition, the glandular changes found in two cases (1.6 %). More importantly, there was one case diagnosed with micro-invasive cervical cancer (0.79 %) and this comprises 0.23 % of our sample.
In view of the size and the heterogeneity of our sample, it is difficult to recommend changing the starting age of the cervical screening programme. However, we strongly recommend to have a low threshold to offering cervical cytology to the women under 25 on clinical basis, particularly, after the recent introduction of HPV triage (outside the scope of this study), which will enable us to avoid the two main disadvantages of the early screening, namely over-diagnosis and over-treatment.
自 2003 年起，英格兰将宫颈癌筛查的年龄门槛从 20 岁提高到 25 岁，因此人们多次呼吁恢复之前的宫颈癌筛查起始年龄，因为人们担心推迟宫颈癌筛查起始年龄可能会增加宫颈癌的风险。我们进行了一项回顾性研究，通过分析英国 2005 年至 2009 年间，在伦敦布鲁姆利自治市 426 名年龄在 25 岁以下的女性进行的宫颈细胞学检查，来分析英格兰将宫颈癌筛查计划起始年龄改为 25 岁的安全性。
我们对 426 名年龄在 25 岁以下的女性进行了回顾性分析，这些女性在 2005 年至 2009 年间因宫颈涂片在布鲁姆利国民保健署被转诊至布鲁姆利医院的阴道镜检查诊所。对 4 年来的阴道镜检查结果和组织学结果进行了回顾和分析。
在我们的研究中，44.80%的涂片显示轻度不典型增生。分别有 23%和 12%的涂片显示中度不典型增生和重度不典型增生。11.2%的涂片为边界性不典型增生，0.2%的涂片显示腺体变化。阴道镜检查显示，只有 16.2%（69 例）被报告为正常；然而，分别有 25.8%和 20%的女性被诊断为低度和高度异常。12%（53 例）的病例显示与 HPV 相关的变化，而未发现疑似恶性肿瘤。根据阴道镜检查结果，228 名女性（约 54%）进行了阴道镜检查指导下的宫颈活检。最常见的组织学发现是 CIN I，占所有活检的 48%（110 例）。然而，分别有 25%（58 例）和 9%（20 例）的女性发现 CIN II 和 CIN III。仅在 1 例（0.44%）中发现腺体变化。为 130 名女性制定了治疗计划，这是转诊至阴道镜检查的 426 名女性中的一个显著比例（30.5%）。活检的组织学检查显示，91%（115 例）的病例存在 CIN，其中 74.8%（86 例）为 CIN II（36 例）或 CIN III（50 例）。此外，在 2 例（1.6%）中发现了腺体变化。更重要的是，有 1 例被诊断为微浸润性宫颈癌（0.79%），占我们样本的 0.23%。
鉴于我们样本的大小和异质性，很难推荐改变宫颈癌筛查计划的起始年龄。然而，我们强烈建议根据临床情况，对 25 岁以下的女性进行宫颈细胞学检查，特别是在最近引入 HPV 三阶梯检测（不在本研究范围内）之后，这将使我们能够避免早期筛查的两个主要缺点，即过度诊断和过度治疗。
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