Koss L G
Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467-2490.
JAMA. 1989 Feb 3;261(5):737-43.
The complex detection system leading to the discovery and treatment of precancerous lesions and early cancer of the uterine cervix is described in detail and discussed. By far the most difficult and underestimated component of this system is the screening and interpretation of cervical (Papanicolaou) smears. Cytologic case finding may fail because of inadequate samples, insufficient time devoted to screening, or human fatigue. Other weak points of the system, such as an inadequate clinical component, inadequate patient compliance, poor reproducibility of diagnoses, and ineffective aftercare, are also described. For example, obtaining a second smear to confirm or refute a diagnosis of cellular atypia is often a misleading practice. Although this cancer detection system has been shown to be effective in reducing the rate of morbidity and mortality from invasive cervical cancer in appropriately screened populations, there is no evidence that the Papanicolaou test has succeeded anywhere in complete eradication of this theoretically preventable disease. It is important to inform the public about the potential failures of the system and the reasons for them.
本文详细描述并讨论了用于发现和治疗子宫颈癌前病变及早期癌症的复杂检测系统。到目前为止，该系统中最困难且被低估的部分是宫颈（巴氏）涂片的筛查和解读。由于样本不足、筛查时间不够或人为疲劳，细胞学病例发现可能会失败。还描述了该系统的其他薄弱环节，如临床部分不足、患者依从性差、诊断的可重复性差以及后续护理无效等。例如，获取第二次涂片以确认或反驳细胞异型性的诊断往往是一种误导性做法。尽管该癌症检测系统已被证明在适当筛查的人群中可有效降低浸润性宫颈癌的发病率和死亡率，但没有证据表明巴氏试验在任何地方成功完全根除了这种理论上可预防的疾病。向公众告知该系统的潜在失败及其原因很重要。
