Hawkes David, Keung Marco H T, Huang Yanping, McDermott Tracey L, Romano Joanne, Saville Marion, Brotherton Julia M L
VCS Foundation, Carlton South, VIC 3053, Australia.
Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, VIC 3010, Australia.
Cancers (Basel). 2020 Apr 24;12(4):1053. doi: 10.3390/cancers12041053.
In 2018, there were an estimated 570,000 new cases of cervical cancer globally, with most of them occurring in women who either had no access to cervical screening, or had not participated in screening in regions where programs are available. Where programs are in place, a major barrier for women across many cultures has been the requirement to undergo a speculum examination. With the emergence of HPV-based primary screening, the option of self-collection (where the woman takes the sample from the vagina herself) may overcome this barrier, given that such samples when tested using a PCR-based HPV assay have similar sensitivity for the detection of cervical pre-cancers as practitioner-collected cervical specimens. Other advantages of HPV-based screening using self-collection, beyond the increase in acceptability to women, include scalability, efficiency, and high negative predictive value, allowing for long intervals between negative tests. Self-collection will be a key strategy for the successful scale up of cervical screening programs globally in response to the WHO call for all countries to work towards the elimination of cervical cancer as a public health problem. This review will examine self-collection for HPV-based cervical screening including the collection devices, assays and possible routine laboratory processes considering how they can be utilized in cervical screening programs.
2018年，全球估计有57万例宫颈癌新发病例，其中大多数发生在无法获得宫颈癌筛查服务的女性身上，或者在有筛查项目的地区未参加筛查的女性身上。在有筛查项目的地方，对于许多文化背景的女性来说，一个主要障碍是需要接受窥器检查。随着基于人乳头瘤病毒（HPV）的初筛方法的出现，自我采样（即女性自己从阴道采集样本）这一选择可能会克服这一障碍，因为使用基于聚合酶链反应（PCR）的HPV检测方法检测这些样本时，对于检测宫颈上皮内瘤变的敏感性与医生采集的宫颈标本相似。基于HPV的自我采样筛查，除了提高女性接受度之外，其他优势还包括可扩展性、效率和高阴性预测值，使得阴性检测之间的间隔时间可以延长。自我采样将成为全球成功扩大宫颈癌筛查项目的关键策略，以响应世界卫生组织呼吁所有国家努力消除宫颈癌这一公共卫生问题的号召。本综述将探讨基于HPV的宫颈癌筛查中的自我采样，包括采集设备、检测方法以及可能的常规实验室流程，并考虑它们如何应用于宫颈癌筛查项目。
