de Sanjosé Silvia, Ibáñez Raquel, Rodríguez-Salés Vanesa, Peris Mercè, Roura Esther, Diaz Mireia, Torné Aureli, Costa Dolors, Canet Yolanda, Falguera Gemma, Alejo Maria, Espinàs Josep Alfons, Bosch F Xavier
Cancer Epidemiology Research Programme, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, 08907, Spain ; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona 08036, Spain.
Cancer Epidemiology Research Programme, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, 08907, Spain.
Ecancermedicalscience. 2015 Apr 29;9:532. doi: 10.3332/ecancer.2015.532. eCollection 2015.
The early detection of intraepithelial lesions of the cervix, through the periodic examination of cervical cells, has been fundamental for the prevention of invasive cervical cancer and its related mortality. In this report, we summarise the cervical cancer screening activities carried out in Catalonia, Spain, within the National Health System during 2008-2011. The study population covers over two million women resident in the area. The evaluation includes 758,690 cervical cytologies performed on a total of 595,868 women. The three-year coverage of cervical cytology among women aged between 25 and 65 years was 40.8%. About 50% of first screened women with negative results had not returned to the second screening round. The introduction of high-risk human papillomavirus DNA (HPV) detection, as a primary screening cotest with cytology among women over age 40 with a poor screening history, significantly improved the detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+), being far superior to cytology alone. Cotesting did not improve the detection of CIN2+. The use of the HPV test for the triage of atypical squamous cell undetermined significance (ASC-US) improved the selection of women at high risk of CIN2+. Sampling (both cytology and HPV test) was largely performed by midwives (66.7%), followed by obstetricians (23.8%) and nurses (7%). Over half of the centres (54.8%) had full use of online medical records. During the study period, educational activities for professionals and for women were carried out periodically. The organisation of screening as a population activity in which women are actively called to the screening visit and the introduction of HPV testing as a primary screening tool are strongly recommended to ensure the maximum population impact in the reduction of the cervical cancer burden.
通过定期检查宫颈细胞来早期发现宫颈上皮内病变，对于预防浸润性宫颈癌及其相关死亡率至关重要。在本报告中，我们总结了2008年至2011年期间西班牙加泰罗尼亚地区在国家卫生系统内开展的宫颈癌筛查活动。研究人群涵盖该地区超过200万女性居民。评估包括对总共595,868名女性进行的758,690次宫颈细胞学检查。25至65岁女性的宫颈细胞学三年覆盖率为40.8%。约50%首次筛查结果为阴性的女性未返回参加第二轮筛查。对于筛查史不佳的40岁以上女性，引入高危型人乳头瘤病毒DNA（HPV）检测作为与细胞学联合的初次筛查方法，显著提高了2级或更高级别宫颈上皮内瘤变（CIN2+）的检出率，远优于单独使用细胞学检查。联合检测并未提高CIN2+的检出率。使用HPV检测对意义不明确的非典型鳞状细胞（ASC-US）进行分流，改善了CIN2+高危女性的选择。采样（细胞学检查和HPV检测）主要由助产士进行（66.7%），其次是产科医生（23.8%）和护士（7%）。超过一半的中心（54.8%）充分利用了在线医疗记录。在研究期间，定期开展了针对专业人员和女性的教育活动。强烈建议将筛查组织为一项人群活动，积极邀请女性参加筛查，并引入HPV检测作为主要筛查工具，以确保在减轻宫颈癌负担方面对人群产生最大影响。
