Fowler Christina I, Saraiya Mona, Moskosky Susan B, Miller Jacqueline W, Gable Julia, Mautone-Smith Nancy
MMWR Morb Mortal Wkly Rep. 2017 Sep 22;66(37):981-985. doi: 10.15585/mmwr.mm6637a4.
Cervical cancer screening is critical to early detection and treatment of precancerous cells and cervical cancer. In 2015, 83% of U.S. women reported being screened per current recommendations, which is below the Healthy People 2020 target of 93% (1,2). Disparities in screening persist for women who are younger (aged 21-30 years), have lower income, are less educated, are uninsured, lack a source of health care, or who self-identify as Asian or American Indian/Alaska Native (2). Women who are never screened or rarely screened are more likely to develop cancer and receive a cancer diagnosis at later stages than women who are screened regularly (3). In 2013, cervical cancer was diagnosed in 11,955 women in the United States, and 4,217 died from the disease (4). Aggregated administrative data from the Title X Family Planning Program were used to calculate the percentage of female clients served in Title X-funded health centers who received a Papanicolaou (Pap) test during 2005-2015. Trends in the percentage of Title X clients screened for cervical cancer were examined in relation to changes in cervical cancer screening guidelines, particularly the 2009 American College of Obstetricians and Gynecologists (ACOG) update that raised the age for starting cervical cancer screening to 21 years (5) and the 2012 alignment of screening guidelines from ACOG, the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) on the starting age (21 years), screening interval (3 or 5 years), and type of screening test (6-8). During 2005-2015, the percentage of female clients screened for cervical cancer dropped continually, with the largest declines occurring in 2010 and 2013, notably a year after major updates to the recommendations. Although aggregated data contribute to understanding of cervical cancer screening trends in Title X centers, studies using client-level and encounter-level data are needed to assess the appropriateness of cervical cancer screening in individual cases.
宫颈癌筛查对于癌前细胞和宫颈癌的早期发现及治疗至关重要。2015年，83%的美国女性报告称按照当前建议进行了筛查，这低于《健康人民2020》设定的93%的目标（1,2）。年龄较小（21 - 30岁）、收入较低、受教育程度较低、未参保、缺乏医疗保健来源或自我认定为亚裔或美洲印第安人/阿拉斯加原住民的女性在筛查方面仍存在差异（2）。与定期接受筛查的女性相比，从未接受筛查或很少接受筛查的女性患癌的可能性更大，且在疾病晚期才会得到癌症诊断（3）。2013年，美国有11,955名女性被诊断出患有宫颈癌，其中4,217人死于该疾病（4）。利用第十类计划生育项目的汇总行政数据来计算在由第十类资金资助的健康中心接受服务的女性客户在2005 - 2015年期间接受巴氏试验的百分比。研究了第十类客户宫颈癌筛查百分比的趋势与宫颈癌筛查指南变化的关系，特别是2009年美国妇产科医师学会（ACOG）将宫颈癌筛查起始年龄提高到21岁的更新（5）以及2012年ACOG、美国预防服务工作组（USPSTF）和美国癌症协会（ACS）在筛查起始年龄（21岁）、筛查间隔（3年或5年）和筛查测试类型方面筛查指南的统一（6 - 8）。在2005 - 2015年期间，接受宫颈癌筛查的女性客户百分比持续下降，最大降幅出现在2010年和2013年，尤其是在建议进行重大更新后的一年。尽管汇总数据有助于了解第十类中心的宫颈癌筛查趋势，但仍需要使用客户层面和就诊层面数据的研究来评估个别病例中宫颈癌筛查的适宜性。
