Rizzo Anthony E, Feldman Sarah
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School Boston, MA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, and the Dana Farber Cancer Institute, Boston, MA.
Curr Probl Cancer. 2018 Sep;42(5):507-520. doi: 10.1016/j.currproblcancer.2018.06.013. Epub 2018 Aug 14.
In the coming decade, primary testing for human papillomavirus (HPV) will likely become the standard of care for cervical cancer screening in both low- and high-resource settings. This change comes as evidence has accumulated to support HPV testing as more sensitive to detect high-grade precancerous disease. Furthermore, negative HPV testing has demonstrated a lower cumulative incidence of cervical intraepithelial neoplasia (CIN) grade 3 or worse pathology (CIN3+) when compared to negative "Pap smears" over several rounds of screening. While many countries have begun pilot programs to transition to primary HPV screening and some have completely transitioned for certain uses, there remains much to be refined about this tool for cervical cancer prevention, as evidenced by the myriad of ways it is being utilized. In the United States, the use of primary HPV testing to screen for cervical cancer has been supported by a consensus statement from the Society of Gynecologic Oncologists and American Society for Colposcopy and Cervical Pathology along with experts from American College of Obstetricians and Gynecologists/American Cancer Society/American Society of Cytopathology/College of American Pathologists/and American Society for Clinical Pathology. Additionally, recently proposed United States Preventive Services Task Force guideline changes, and recent Food and Drug Administration approval of the second test for primary HPV screening highlight the broadening availability and support for primary HPV screening. The aim of this review is to summarize the evidence supporting the safety and effectiveness of primary HPV screening and its use in different high-resource settings.
在未来十年，人乳头瘤病毒（HPV）初筛可能会成为资源匮乏地区和资源丰富地区宫颈癌筛查的标准医疗方案。这一变化的出现是因为已有越来越多的证据支持HPV检测在检测高级别癌前病变方面更为敏感。此外，与多次筛查中呈阴性的“巴氏涂片”相比，HPV检测呈阴性者发生宫颈上皮内瘤变（CIN）3级或更严重病变（CIN3+）的累积发病率更低。虽然许多国家已启动向HPV初筛过渡的试点项目，有些国家已在某些用途上完全过渡，但在宫颈癌预防这一工具方面仍有许多需要完善之处，其使用方式繁多就证明了这一点。在美国，妇科肿瘤学家协会、美国阴道镜及宫颈病理学会以及来自美国妇产科医师学会/美国癌症协会/美国细胞病理学会/美国病理学家学会/美国临床病理学会的专家们达成的共识声明支持使用HPV初筛来筛查宫颈癌。此外，美国预防服务工作组最近提议的指南变更，以及美国食品药品监督管理局最近批准的第二种HPV初筛检测方法，都凸显了HPV初筛的可及性和支持度在不断扩大。本综述的目的是总结支持HPV初筛安全性和有效性及其在不同资源丰富地区应用的证据。
