Kuhn Louise, Denny Lynette
Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
Department of Obstetrics and Gynaecology, University of Cape Town, South Africa; South African Medical Research Council, Gynaecological Cancer Research Centre, South Africa.
Prev Med. 2017 May;98:42-44. doi: 10.1016/j.ypmed.2016.12.030. Epub 2017 Feb 6.
Unacceptable disparities in cervical cancer between richer and poorer countries persist and serve as reminders of gross disparities in access to and quality of screening services. HPV testing is well-suited to address some of the barriers to implementing adequate screening programs in low resource settings. HPV testing has considerably better sensitivity than cytology providing the same extent of safety with fewer rounds of screening. New robust HPV testing platforms require little to no skill by laboratory workers and some can be used at the point-of-care. This allows for a round of screening to be accomplished in one or two visits, reducing costs and the inevitable attrition that occurs when women need to be recalled to obtain their results. HPV testing is ideal for incorporating into the new "screen-and-treat" approaches designed to overcome limitations of conventional, multi-visit, colposcopy-based approaches to screening. Visual inspection with acetic acid (VIA) is the screening test that has been used most widely in screen-and-treat programs to date but the performance characteristics of this test are poor. HPV-based screen-and-treat is more effective in reducing disease in the population and reduces over-treatment intrinsic to this approach. HPV testing can be adapted or combined with other molecular tests to improve treatment algorithms. Infrastructure established to support VIA-based screen-and-treat can effectively incorporate HPV testing. We are poised at a critical juncture in public health history to implement HPV testing as part of primary screening and thereby improve women's health in low resource settings.
富裕国家和贫穷国家在宫颈癌方面存在不可接受的差距，这提醒人们在筛查服务的可及性和质量方面存在巨大差异。HPV检测非常适合解决在资源匮乏地区实施适当筛查计划的一些障碍。HPV检测的灵敏度比细胞学检测高得多，在相同的安全程度下，筛查轮次更少。新型强大的HPV检测平台对实验室工作人员的技能要求很低或几乎没有要求，有些还可以在护理点使用。这使得一轮筛查可以在一两次就诊中完成，降低了成本以及女性需要被召回获取结果时不可避免的损耗。HPV检测非常适合纳入新的“筛查即治疗”方法，以克服传统的、多次就诊的、基于阴道镜检查的筛查方法的局限性。醋酸肉眼观察法（VIA）是迄今为止在筛查即治疗计划中使用最广泛的筛查测试，但该测试的性能特征较差。基于HPV的筛查即治疗在减少人群疾病方面更有效，并减少了这种方法固有的过度治疗。HPV检测可以进行调整或与其他分子检测相结合，以改进治疗算法。为支持基于VIA的筛查即治疗而建立的基础设施可以有效地纳入HPV检测。我们正处于公共卫生历史的关键时刻，将HPV检测作为初级筛查的一部分加以实施，从而改善资源匮乏地区女性的健康状况。
