Lees Brittany F, Erickson Britt K, Huh Warner K
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL.
Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN.
Am J Obstet Gynecol. 2016 Apr;214(4):438-443. doi: 10.1016/j.ajog.2015.10.147. Epub 2015 Oct 28.
Cervical cancer screening involves a complex process of cytology, human papillomavirus (HPV) testing, colposcopy, and a multitude of algorithms for the identification of preinvasive disease and prevention of invasive disease. High-risk HPV is a prerequisite for the development of almost all types of cervical cancer; therefore, a test for high-risk HPV has become an integral part of new screening strategies. Major changes to screening guidelines in the last decade include initiation of screening at age 21 years, conservative management of young women with abnormal cytology, extended screening intervals for women age ≥30 years, and cessation of screening in low-risk women at age 65 years. This review will focus on the evidence that has led to the current evidence-based guidelines. Evidence regarding primary HPV testing as well as postvaccine-based screening strategies will also be reviewed.
宫颈癌筛查涉及细胞学、人乳头瘤病毒（HPV）检测、阴道镜检查等复杂过程，以及众多用于识别癌前病变和预防浸润性疾病的算法。高危型HPV是几乎所有类型宫颈癌发生的先决条件；因此，高危型HPV检测已成为新筛查策略的一个组成部分。过去十年筛查指南的主要变化包括：21岁开始筛查、对细胞学异常的年轻女性进行保守管理、≥30岁女性延长筛查间隔、65岁低风险女性停止筛查。本综述将聚焦于形成当前循证指南的证据。还将综述关于HPV初筛以及基于疫苗接种后的筛查策略的证据。
