Rodríguez Ana Cecilia, Salmerón Jorge
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
Mexican Institute of Social Security, Ciudad de Mexico, Mexico; Hospital Infantil de México Federico Gómez, Ciudad de Mexico, Mexico.
Prev Med. 2017 May;98:36-38. doi: 10.1016/j.ypmed.2016.12.032. Epub 2017 Feb 6.
The manuscripts by Tota et al. and by Rossi et al., in this issue of Preventive Medicine provide ample evidence regarding the urgent need to switch to HPV based screening programs and how it will become even more imperative once HPV vaccinated girls reach the cervical cancer screening age. Worldwide primary prevention with vaccination is the final goal; but, in the coming 2 to 3 decades most of the prevention should be done through screening and treatment of precancerous lesions. Cervical cancer remains a major public health problem in upper-middle income countries (UMICs). Coverage of vaccination against HPV by the end of 2014 was estimated to be <10% for girls and young women 10 to 20years with nearly no vaccination among older women. Therefore, multiple cohorts of women will remain dependent on secondary screening for cervical cancer prevention in the coming decades. Several UMICs currently have cytology-based screening programs with limited effectiveness. In addition to the limitations of cytology, summarized by Tota et al., screening programs in UMICs have other problems that further reduce their effectiveness including low programmatic coverage due to poor accessibility to health services and loss to follow-up of women screening positive. Cervical cancer prevention programs in UMICs should be urgently transformed to become more cost-efficient and most importantly more effective in reducing cervical cancer burden. Introduction of HPV vaccination where it is not available and where available, assuring high vaccination coverage among girls is a must. Screening programs should switch to HPV testing immediately while simultaneously solving other program deficiencies.
本期《预防医学》中托塔等人和罗西等人的手稿提供了充分证据，证明迫切需要转向基于人乳头瘤病毒（HPV）的筛查项目，以及一旦接种HPV疫苗的女孩达到宫颈癌筛查年龄，这种需求将变得更加迫切。在全球范围内，通过疫苗接种进行一级预防是最终目标；但是，在未来二三十年里，大部分预防工作应通过对癌前病变的筛查和治疗来完成。宫颈癌在中高收入国家（UMICs）仍然是一个重大的公共卫生问题。据估计，截至2014年底，10至20岁女孩和年轻女性的HPV疫苗接种覆盖率不到10%，老年女性几乎没有接种。因此，在未来几十年里，多组女性仍将依赖二级筛查来预防宫颈癌。目前，一些中高收入国家有基于细胞学的筛查项目，但效果有限。除了托塔等人总结的细胞学的局限性外，中高收入国家的筛查项目还有其他问题，进一步降低了其有效性，包括由于获得医疗服务的机会差导致的项目覆盖率低，以及筛查呈阳性的女性失访。中高收入国家的宫颈癌预防项目应立即进行改革，以提高成本效益，最重要的是更有效地减轻宫颈癌负担。在没有HPV疫苗接种的地方引入该疫苗，在有疫苗接种的地方，确保女孩有高接种覆盖率是必须的。筛查项目应立即转向HPV检测，同时解决其他项目缺陷。
