Perkins Rebecca B, Guido Richard L, Saraiya Mona, Sawaya George F, Wentzensen Nicolas, Schiffman Mark, Feldman Sarah
Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, USA.
University of Pittsburgh/Magee-Women's Hospital, Pittsburgh, Pennsylvania, USA.
J Womens Health (Larchmt). 2021 Jan;30(1):5-13. doi: 10.1089/jwh.2020.8918.
Cervical cancer can be prevented through routine screening and follow-up of abnormal results. Several guidelines have been published in the last 4 years from various medical societies and organizations. These guidelines aim to personalize screening and management, reducing unnecessary testing in low-risk patients and managing high-risk patients with more intensive follow-up. However, the resulting complexity can lead to confusion among providers. The CDC, NCI, and obstetrician-gynecologists involved in guideline development summarized current screening and management guidelines. For screening, guidelines for average-risk and high-risk populations are summarized and presented. For management, differences between the 2012 and 2019 consensus guidelines for managing abnormal cervical cancer screening tests and cancer precursors are summarized. Current screening guidelines for average-risk individuals have minor differences, but are evolving toward an HPV-based strategy. For management, HPV testing is preferred to cytology because it is a more sensitive test for cancer precursor detection and also allows for precise risk stratification. Current risk-based screening and management strategies can improve care by reducing unnecessary tests and procedures in low-risk patients and focusing resources on high-risk patients. Knowledge of screening and management guidelines is important to improve adherence and avoid both over- and under-use of screening and colposcopy.
宫颈癌可通过常规筛查及对异常结果的随访来预防。在过去4年里,各个医学协会和组织已发布了多项指南。这些指南旨在实现筛查和管理的个性化,减少低风险患者的不必要检测,并对高风险患者进行更密集的随访管理。然而,由此产生的复杂性可能会导致医疗服务提供者之间的困惑。参与指南制定的美国疾病控制与预防中心(CDC)、美国国立癌症研究所(NCI)以及妇产科医生总结了当前的筛查和管理指南。对于筛查,总结并介绍了平均风险和高风险人群的指南。对于管理,总结了2012年和2019年关于管理异常宫颈癌筛查检测和癌症前体的共识指南之间的差异。当前针对平均风险个体的筛查指南存在细微差异,但正朝着基于人乳头瘤病毒(HPV)的策略发展。对于管理而言,HPV检测优于细胞学检查,因为它对癌症前体检测更为敏感,还能进行精确的风险分层。当前基于风险的筛查和管理策略可通过减少低风险患者的不必要检测和程序,并将资源集中于高风险患者来改善医疗服务。了解筛查和管理指南对于提高依从性以及避免筛查和阴道镜检查的过度使用和使用不足都很重要。