Fokom-Domgue Joël, Vassilakos Pierre, Petignat Patrick
Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland; Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Cameroon.
Geneva Foundation for Medical Education and Research, Geneva, Switzerland.
Prev Med. 2014 Aug;65:138-40. doi: 10.1016/j.ypmed.2014.05.014. Epub 2014 May 28.
The World Health Organization guidelines for screening and management of cervical precancerous lesions updated in 2013 made an emphasis on the use of the 'screen-and-treat' approach for cervical cancer prevention. In order to facilitate scaling-up in low income settings, most of these screen-and-treat strategies do not involve confirmatory biopsy. This yields a certain rate of overtreatment. In other words, a majority of people undergoing screen-and-treat intervention who are treated does not necessarily benefit from the treatment. Therefore, the issue of potential short term and long term complications of the recommended treatment procedures (cryotherapy and Loop Electrosurgical Excision Procedure) arises. This question has seldom been studied in resource poor countries, particularly in Sub-Saharan Africa where Human Immunodeficiency Virus infection is rampant in an epidemic fashion and where the procreative capacities are socially rewarding for women. We draw the attention of the scientific community and policy makers to the fact that the lack of evidence supporting the safety of these treatment procedures in African populations may have an impact on the acceptability of these strategies and therefore on the effectiveness of screening programs.
世界卫生组织2013年更新的子宫颈癌前病变筛查和管理指南强调采用“筛查即治疗”方法预防宫颈癌。为便于在低收入环境中扩大规模，这些筛查即治疗策略大多不涉及确诊性活检。这导致了一定比例的过度治疗。换句话说，接受筛查即治疗干预并接受治疗的大多数人不一定能从治疗中获益。因此，出现了推荐治疗程序（冷冻疗法和环形电切术）潜在的短期和长期并发症问题。在资源匮乏的国家，特别是在撒哈拉以南非洲地区，这个问题很少得到研究，在该地区，人类免疫缺陷病毒感染呈流行态势猖獗，而且生育能力对女性来说在社会层面是有益的。我们提请科学界和政策制定者注意，缺乏支持这些治疗程序在非洲人群中安全性的证据，可能会影响这些策略的可接受性，进而影响筛查项目的有效性。
