Am J Epidemiol. 2013 Oct 1;178(7):1023-6; discussion 1027. doi: 10.1093/aje/kwt171. Epub 2013 Aug 21.
Changes in screening guidelines that imply suppression of procedures once recommended are always controversial because of the perception that benefits are being curtailed. Prior to 2012, cervical cancer screening guidelines issued by US-based expert bodies differed in several decision areas, making clinicians essentially cherry-pick among recommendations. To some extent, this approach to screening practices also served to shield clinicians from litigation. It implied starting screening earlier, doing it more frequently, and stopping later in life than necessary. This state of affairs changed in 2012, when the most influential professional groups updated their cervical screening guidelines, and recommendations became essentially unified. All groups recommended that women older than 65 years of age discontinue cervical cancer screening on the basis of evidence that screening benefits in this age group were minor and far outweighed by harms. The guidelines are very specific about the exceptions, which ensure acceptable safety. It is expected that the new guidelines will permit less wasteful cervical screening, while fostering the opportunity to direct resources towards ensuring adequate coverage of high-risk women.
筛查指南的变化暗示着曾经推荐的程序被抑制，这总是会引起争议，因为人们认为这会减少获益。在 2012 年之前，美国专家机构发布的宫颈癌筛查指南在几个决策领域存在差异，这使得临床医生基本上可以在建议中进行选择。在某种程度上，这种筛查方法也有助于保护临床医生免受诉讼。这意味着筛查开始得更早，更频繁，而且在生命后期停止得更早，这是不必要的。这种情况在 2012 年发生了变化，当时最有影响力的专业团体更新了他们的宫颈癌筛查指南，建议基本上变得统一了。所有团体都建议，年龄大于 65 岁的妇女应该根据证据停止宫颈癌筛查，因为该年龄组的筛查获益较小，而危害远远超过获益。这些指南非常具体地说明了例外情况，以确保可接受的安全性。预计新指南将减少浪费性的宫颈癌筛查，同时为确保高危妇女得到充分覆盖提供机会。
