Spencer Jennifer C, Wheeler Cosette M
Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Texas.
Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas.
Cancer Epidemiol Biomarkers Prev. 2024 Aug 1;33(8):982-983. doi: 10.1158/1055-9965.EPI-24-0716.
Cervical cancer screening has reduced morbidity and mortality in many countries, but efforts to optimize screening modalities and schedules are ongoing. Using data from a randomized trial conducted in British Columbia, Canada, in conjunction with a provincial screening registry, Gottschlich and colleagues demonstrated that the estimated risk for precancerous disease (cervical intraepithelial neoplasia grades 2 or worse) at 8 years following a negative human papillomavirus (HPV) test was similar to the current standard of care (Pap testing after 3 years). The study supports extending screening intervals for those with a negative HPV test beyond currently recommended 5-year intervals. In an ideal world, the resources saved through less frequent routine cervical screening could be redirected to increasing screening uptake and follow-up of abnormalities to improve equity in cervical cancer prevention. However, implementation of extending screening intervals remains less than straightforward in settings with fragmented healthcare systems that lack information systems to support patient call/recall, such as the United States. To achieve the full promise of primary HPV testing, stakeholders at every level must commit to identifying and addressing the diverse spectrum of barriers that undergird existing inequities in care access, appropriately resource implementation strategies, and improve health information systems. See related article by Gottschlich et al., p. 904.
宫颈癌筛查已在许多国家降低了发病率和死亡率，但优化筛查方式和时间表的工作仍在进行中。戈特施利希及其同事利用在加拿大不列颠哥伦比亚省进行的一项随机试验的数据，并结合省级筛查登记处的数据，证明了人乳头瘤病毒（HPV）检测呈阴性后8年时癌前疾病（宫颈上皮内瘤变2级或更严重）的估计风险与当前的标准护理（3年后进行巴氏试验）相似。该研究支持将HPV检测呈阴性者的筛查间隔延长至超过目前建议的5年间隔。在理想情况下，通过减少常规宫颈癌筛查频率节省下来的资源可以重新用于提高筛查参与率和对异常情况的随访，以改善宫颈癌预防方面的公平性。然而，在像美国这样医疗保健系统分散且缺乏支持患者呼叫/召回的信息系统的环境中，延长筛查间隔的实施仍并非易事。为了充分实现初级HPV检测的前景，各级利益相关者必须致力于识别和解决构成现有医疗服务获取不平等基础的各种障碍，适当地为实施策略提供资源，并改善健康信息系统。见戈特施利希等人的相关文章，第904页。
