Rebolj Matejka, Mathews Christopher S, Pesola Francesca, Castañon Alejandra, Kitchener Henry
Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
Division of Cancer Sciences, University of Manchester, Manchester, UK.
Int J Cancer. 2022 May 1;150(9):1412-1421. doi: 10.1002/ijc.33900. Epub 2021 Dec 31.
Several international cervical screening guidelines advise against using high-risk human papillomavirus (HR-HPV) testing in women younger than 30. The rationale for this in young women, lies in the potential for additional detection of both low-grade and high-grade cervical intraepithelial neoplasia (CIN) leading to unnecessary treatments without reducing the burden of cervical cancer. We studied 56 544 women screened at 24 to 29 with HR-HPV testing and 116 858 screened with liquid-based cytology (LBC) in the English HPV screening pilot. They were compared to 528 460 women screened at the age of 30 to 49. We studied the detection of cervical cancer and CIN2/3 across two consecutive screening rounds 3 years apart. At 24 to 29, a positive HR-HPV test detected more cases of cervical cancer in the prevalence round than did a positive LBC test (1.36/1000 screened vs 0.82/1000, OR : 1.61, 95% CI: 1.18-2.19). In women with a negative HR-HPV test, cervical cancer was diagnosed before or at the incidence round in 0.07/1000. After a negative LBC test, cancer detection reached 0.47/1000 and 40% of these cases were diagnosed at FIGO stage IB+. HR-HPV testing increased the detection of CIN2/3 diagnoses in two consecutive rounds combined by 30% (71.9/1000 vs 55.2/1000). The patterns of detection of cervical cancer and CIN2/3 were almost identical at older ages. These data support using HR-HPV testing for screening of women younger than 30, which not only accelerates the diagnosis of cervical cancer but leads to a similar relative increase in CIN2/3 diagnosis to that found in women aged 30 to 49.
多项国际宫颈癌筛查指南建议，不应对30岁以下女性进行高危型人乳头瘤病毒（HR-HPV）检测。对于年轻女性而言，这样做的理由在于，检测出低级别和高级别宫颈上皮内瘤变（CIN）的可能性增加，这会导致不必要的治疗，却无法减轻宫颈癌负担。我们在英国HPV筛查试点项目中，研究了56544名年龄在24至29岁之间接受HR-HPV检测的女性，以及116858名接受液基细胞学（LBC）检测的女性。将她们与528460名年龄在30至49岁之间接受筛查的女性进行比较。我们研究了相隔3年的连续两轮筛查中宫颈癌和CIN2/3的检出情况。在24至29岁的女性中，在患病率筛查轮次中，HR-HPV检测呈阳性比LBC检测呈阳性能检测出更多宫颈癌病例（每1000名筛查者中分别为1.36例和0.82例，比值比：1.61，95%置信区间：1.18-2.19）。在HR-HPV检测呈阴性的女性中，每1000名中有0.07例在发病前或发病轮次被诊断为宫颈癌。LBC检测呈阴性后，癌症检出率达到每1000名中有0.47例，其中40%的病例在国际妇产科联盟（FIGO）IB+期被诊断出来。HR-HPV检测使连续两轮联合检测中CIN2/3诊断的检出率提高了30%（每1000名中分别为71.9例和55.2例）。在年龄较大的女性中，宫颈癌和CIN2/3的检出模式几乎相同。这些数据支持对30岁以下女性进行HR-HPV检测用于筛查，这不仅能加速宫颈癌的诊断，而且能使CIN2/3诊断的相对增加量与30至49岁女性中的情况相似。
