Davis Michelle, Feldman Sarah
Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Curr Treat Options Oncol. 2015 Dec;16(12):55. doi: 10.1007/s11864-015-0373-1.
Since the publication of the American Cancer Society (ACS)/American Society for Colposcopy and Cervical Pathology (ASCCP)/American Society for Clinical Pathology (ASCP) clinical guidelines in 2012, the majority of practice organizations have reached a consensus on screening recommendations for a low-risk population. These guidelines were based on a thorough review of the evidence with reproducible methods to obtain high-quality, generalizable guidelines. Despite the strength of the evidence based recommendations comprising these guidelines, limitations in physician understanding and compliance remain with respect to reaching an unscreened population and defining and caring for women who are at "high risk." "High-risk" patients are poorly characterized but should include women with a history of a prior abnormal screening, as data has shown a subsequent increased risk of cervical intraepithelial neoplasia grade 2 (CIN2) or greater, even after treatment. These women warrant more intense screening than the general population-though there are no evidence-based guidelines for optimized screening protocols in this population. Emerging data in cervical cancer screening this year includes the FDA approval of primary high-risk human papillomavirus (HPV) testing. While the data is promising, its role in clinical practice, impact on rates of colposcopy in a non-study population, and long-term outcomes are not fully understood, and ongoing research is needed. Challenges remain in this shifting environment on the optimal interval and modality for cervical cancer screening to provide the greatest benefit in detection of precancerous lesions while minimizing the harm of overtreatment. While rapid advancements in research provide improved knowledge on how to treat and prevent this disease, it is often difficult for providers across multiple specialties to remain abreast of these changes and to educate their patients about the most current recommendations. Ultimately, provider and patient education is critical both for improving primary prevention with HPV vaccination, as well as for the uptake of evidence-based screening and management guidelines aimed at detecting and treating precancerous changes of the cervix.
自美国癌症协会（ACS）/美国阴道镜及宫颈病理学会（ASCCP）/美国临床病理学会（ASCP）2012年发布临床指南以来，大多数医疗机构已就低风险人群的筛查建议达成共识。这些指南基于对证据的全面审查，并采用可重复的方法以获得高质量、可推广的指南。尽管这些指南所包含的基于证据的建议很有力，但在接触未接受筛查的人群以及界定和护理“高风险”女性方面，医生的理解和依从性仍存在局限性。“高风险”患者的特征描述不佳，但应包括有既往异常筛查史的女性，因为数据显示，即使经过治疗，她们随后发生宫颈上皮内瘤变2级（CIN2）或更高级别病变的风险仍会增加。这些女性需要比普通人群更密集的筛查——尽管目前尚无针对该人群优化筛查方案的循证指南。今年宫颈癌筛查的新数据包括美国食品药品监督管理局（FDA）批准了高危型人乳头瘤病毒（HPV）初筛检测。虽然数据很有前景，但其在临床实践中的作用、对非研究人群阴道镜检查率的影响以及长期结果尚未完全明确，仍需进行持续研究。在这种不断变化的环境中，宫颈癌筛查的最佳间隔时间和方式仍存在挑战，即在最大程度地发现癌前病变的同时，将过度治疗的危害降至最低。虽然研究的快速进展使人们对如何治疗和预防这种疾病有了更多了解，但多个专业的医疗服务提供者往往难以跟上这些变化，并向患者宣传最新的建议。最终，对医疗服务提供者和患者的教育对于通过HPV疫苗接种改善一级预防，以及采用旨在检测和治疗宫颈癌前病变的循证筛查和管理指南都至关重要。
