Carl R. Darnall Army Medical Center, Fort Hood, TX, USA.
Bassett Army Community Hospital, Fort Wainwright, AK, USA.
Am Fam Physician. 2018 Apr 1;97(7):441-448.
Screening in women has decreased the incidence and mortality of cervical cancer. Precancerous cervical lesions (cervical intraepithelial neoplasias) and cervical carcinomas are strongly associated with sexually-transmitted high-risk human papillomavirus (HPV) infection, which causes more than 99% of cervical cancers. Screening methods include cytology (Papanicolaou test) and HPV testing, alone or in combination. The American Academy of Family Physicians and the U.S. Preventive Services Task Force recommend starting screening in immunocompetent, asymptomatic women at 21 years of age. Women 21 to 29 years of age should be screened every three years with cytology alone. Women 30 to 65 years of age should be screened every five years with cytology plus HPV testing or every three years with cytology alone. Screening is not recommended for women younger than 21 years or in women older than 65 years with an adequate history of negative screening results. The U.S. Preventive Services Task Force is in the process of updating its guidelines. In 2015, the American Society for Colposcopy and Cervical Pathology and the Society of Gynecologic Oncology published interim guidance for the use of primary HPV testing.
筛查女性可降低宫颈癌的发病率和死亡率。癌前宫颈病变（宫颈上皮内瘤变）和宫颈癌与性传播的高危型人乳头瘤病毒（HPV）感染密切相关，超过 99%的宫颈癌由 HPV 感染引起。筛查方法包括细胞学（巴氏试验）和 HPV 检测，单独或联合使用。美国家庭医生学会和美国预防服务工作组建议在免疫功能正常、无症状的女性中，从 21 岁开始进行筛查。21 至 29 岁的女性应每 3 年单独进行细胞学筛查。30 至 65 岁的女性应每 5 年进行细胞学加 HPV 检测，或每 3 年单独进行细胞学筛查。不建议对 21 岁以下或 65 岁以上有充分阴性筛查结果史的女性进行筛查。美国预防服务工作组正在更新其指南。2015 年，美国阴道镜和宫颈病理学会以及妇科肿瘤学会发布了关于初次 HPV 检测应用的临时指南。
