Robertson Gregory, Robson Stephen J
University of New South Wales, School of Women's and Children's Health, Randwick, Sydney, NSW 2031, Australia; Centre for Gynaecological Oncology, Royal Hospital for Women, Randwick, Sydney, NSW 2031, Australia.
Australian National University Medical School, Garran, ACT 2605, Australia.
J Oncol. 2016;2016:3056407. doi: 10.1155/2016/3056407. Epub 2016 Apr 30.
Background. Excisional treatment of preinvasive cervical dysplasia has been associated with adverse pregnancy outcomes. We aimed to examine trends in the rate of excisional treatment in reproductive age women in the era of HPV vaccination. Methods. National data for Australia regarding histological diagnoses of cervical dysplasia and excisional treatment for the period from 2004 to 2013 inclusive were obtained from two datasets and used to calculate age-stratified incidence rates of excisional treatment and of excisional treatments per diagnosis of dysplasia. Results. The incidence of low-grade squamous dysplasia fell in all age groups, while the incidence of high-grade dysplasia fell in the 20-to-24-year group but rose slightly for older age groups. The rate of excisional treatment fell in women aged under 35 but there was no significant change for women 35 years or older. The rate of all excisional treatments (loop excision + cone biopsy) per high-grade diagnosis (CIN2 + CIN3 + adenocarcinoma in situ) fell across all three age-bands in both datasets. Conclusion. To ensure that the use of excisional treatment is appropriate, with lower rates for younger HPV-vaccinated women, close surveillance, audit, and ongoing education will be required.
背景。宫颈原位发育异常的切除治疗与不良妊娠结局相关。我们旨在研究人乳头瘤病毒（HPV）疫苗接种时代育龄女性切除治疗率的趋势。方法。从两个数据集获取了澳大利亚2004年至2013年（含）期间宫颈发育异常组织学诊断和切除治疗的全国数据，并用于计算按年龄分层的切除治疗发病率以及每次发育异常诊断的切除治疗率。结果。所有年龄组的低级别鳞状发育异常发病率均下降，而高级别发育异常的发病率在20至24岁年龄组下降，但在年龄较大的组中略有上升。35岁以下女性的切除治疗率下降，但35岁及以上女性无显著变化。在两个数据集中，所有三个年龄组中每个高级别诊断（CIN2 + CIN3 +原位腺癌）的所有切除治疗（环形切除 + 锥形活检）率均下降。结论。为确保切除治疗的使用得当，使接种HPV疫苗的年轻女性的切除治疗率较低，将需要密切监测、审核和持续教育。
