Department of Pathology, VU University Medical Center, Amsterdam.
Ann Oncol. 2014 May;25(5):927-35. doi: 10.1093/annonc/mdt538. Epub 2014 Jan 19.
Cytology-based nation-wide cervical screening has led to a substantial reduction of the incidence of cervical cancer in western countries. However, the sensitivity of cytology for the detection of high-grade precursor lesions or cervical cancer is limited; therefore, repeated testing is necessary to achieve program effectiveness. Additionally, adenocarcinomas and its precursors are often missed by cytology. Consequently, there is a need for a better screening test. The insight that infection with high-risk human papillomavirus (hrHPV) is the causal agent of cervical cancer and its precursors has led to the development of molecular tests for the detection of hrHPV. Strong evidence now supports the use of hrHPV testing in the prevention of cervical cancer. In this review, we will discuss the arguments in favor of, and concerns on aspects of implementation of hrHPV testing in primary cervical cancer screening, such as the age to start hrHPV-based screening, ways to increase screening attendance, requirements for candidate hrHPV tests to be used, and triage algorithms for screen-positive women.
细胞学为基础的全国性子宫颈筛查已导致西方国家子宫颈癌发病率的显著降低。然而，细胞学检测高级别前体病变或子宫颈癌的敏感性有限；因此，为了实现项目效果，需要重复检测。此外，细胞学常常会漏诊腺癌及其前体病变。因此，需要更好的筛查试验。现已明确，高危型人乳头瘤病毒（hrHPV）感染是子宫颈癌及其前体病变的致病因素，这导致了用于检测 hrHPV 的分子检测的发展。目前有强有力的证据支持在子宫颈癌预防中使用 hrHPV 检测。在这篇综述中，我们将讨论支持和关注在子宫颈癌初级筛查中实施 hrHPV 检测的各方面问题，例如开始基于 hrHPV 的筛查的年龄、提高筛查参与度的方法、候选 hrHPV 检测的要求，以及筛查阳性女性的分流算法。
