Grabinski Emma, Dunsmoor-Su Rebecca
Department of OBGYN, Swedish Medical Group.
Department of OBGYN, Seattle Clinical Research, Seattle, Washington, USA.
Curr Opin Obstet Gynecol. 2023 Apr 1;35(2):160-163. doi: 10.1097/GCO.0000000000000859.
To review the recommendations for cervical cancer screening in older women and to determine the evidence upon which the current and emerging recommendations are based on. To evaluate the possible consequences of stopping cervical cancer screening in older women.
Recommendations are to space cervical cancer screening intervals for women aged 21-65 and stop in women older than 65. Cervical cancer incidence and mortality burden are significant in women over the age of 65. Human papillomavirus (HPV) vaccination rates are poor in older women. Advanced cervical cancer rates are increasing, including adenocarcinoma rates. Vulvar carcinoma rates are also increasing, and gynecological care and exams are less frequent when women are not getting routine pap testing.
The current review shows that there is limited evidence on which to base the recommendation to stop screening. There is confusion among patients and physicians, and other healthcare providers over who to screen and when, and this is exacerbating the already known difficulty accessing healthcare among racial and ethnic minorities, underinsured, and rural populations, but rates of cancer are also rising most rapidly in white women. Recommendations to space or stop screening are often based on the perceived psychological distress of women undergoing testing and the cost of population screening.
回顾针对老年女性宫颈癌筛查的建议，并确定当前及新出现的建议所依据的证据。评估停止老年女性宫颈癌筛查可能产生的后果。
建议21至65岁女性延长宫颈癌筛查间隔时间，65岁以上女性停止筛查。65岁以上女性宫颈癌的发病率和死亡率负担较重。老年女性人乳头瘤病毒（HPV）疫苗接种率较低。晚期宫颈癌发病率在上升，包括腺癌发病率。外阴癌发病率也在上升，且女性不进行常规巴氏检查时，妇科护理和检查次数会减少。
当前综述表明，支持停止筛查建议的证据有限。患者、医生及其他医疗服务提供者对于筛查对象和筛查时间存在困惑，这加剧了少数族裔、未充分参保者及农村人口在获取医疗服务方面本就已知的困难，但白人女性的癌症发病率上升速度也最快。延长或停止筛查的建议通常基于接受检测女性的感知心理压力及群体筛查成本。
