Center for Cervical Cancer Prevention, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden and Karolinska University Hospital, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
Prev Med. 2021 Mar;144:106382. doi: 10.1016/j.ypmed.2020.106382. Epub 2020 Dec 25.
We here discuss human papillomavirus (HPV)-based screening avenues to achieve elimination of cervical cancer as a public health problem in high-income country (HIC) settings, covering both the most recent data on the performance of HPV testing, as well as the currently most robust triage methods that are known. We also provide an outlook to several other promising, yet not fully established, options for triage that have been proposed, including methylation, dual staining, machine learning, and artificial intelligence. Finally, we discuss the key issue of how to adapt screening in the presence of programmatic HPV vaccination, and how this combination can best be leveraged for comprehensive cancer control. We conclude that, for the HIC setting, evidence-based and effective cervical screening methods are readily available, but whichever method or platform is chosen, we would propose that recurring audits of performance and population attendance remain common denominators for maintaining successful disease prevention.
我们在此讨论了人乳头瘤病毒（HPV）筛查途径，以实现消除高收入国家（HIC）宫颈癌这一公共卫生问题，其中涵盖了 HPV 检测最新数据，以及目前已知的最可靠的分流方法。我们还展望了其他几种有前途但尚未完全确立的分流选择，包括甲基化、双重染色、机器学习和人工智能。最后，我们讨论了在 HPV 疫苗接种计划存在的情况下如何调整筛查的关键问题，以及如何最好地利用这种组合进行综合癌症控制。我们的结论是，对于 HIC 环境，基于证据的有效宫颈癌筛查方法是现成的，但无论选择哪种方法或平台，我们都建议对性能和人群参与情况进行定期审核，作为保持成功预防疾病的共同标准。
