Ellis L B, Bowden S J, Lyons D, Kyrgiou M
BJOG. 2025 Jul 30. doi: 10.1111/1471-0528.18262.
Cervical cancer remains a preventable yet significant healthcare problem for women globally. The World Health Organization (WHO) announced a call to eliminate cervical cancer in 2018, with recommendations for screening, vaccination, and treatment of precancerous cervical lesions. Screening uptake is on the decline in the UK, particularly for younger women, where the rate has now dropped below 70%. Primary screening is now performed with high-risk human papillomavirus (hrHPV) testing. This test is sensitive, but not specific, meaning it is good at not missing cancers or precancer, but most people who test hrHPV positive will not have cervical cancer or precancer, and therefore testing positive can lead to unnecessary worry. Any samples that test positive for the virus undergo 'reflex' cytology (the process by which cells suspended in liquid are stained and examined under the microscope by those trained to perform this assessment). This means only virus-positive samples are tested to select patients for colposcopy (visualisation of the cervix with special lenses, in a specialist gynaecology clinic). Other possibilities for this triage test, which may improve the accuracy of screening, are currently under investigation and include methylation (a chemical change in DNA that can be measured) testing, and testing for specific markers. HPV type 16 is the most common high-risk strain found globally, including in the UK. The UK national vaccination programme was started in 2008, and uptake in the UK is currently around 80%. Since 2021, Gardasil9 (offering protection against seven hrHPV types and two HPV types that cause genital warts) has been offered to both boys and girls, at school, aged 12-13. In 2023, new guidance from the Joint Committee on Vaccination and Immunisation (JCVI) recommended a single dose as sufficient. HPV vaccination has almost eliminated cervical cancer in those born in or after 1995. Future directions for the screening programme in the UK include self-sampling, adaptations in the post-vaccine era, and increasing the upper age limit of screening. Self-sampling has been shown to be similarly accurate to clinician-taken samples, and may be a good option for those who do not attend for screening, who have been shown to have increased risk of cervical cancer and worse outcomes. One in ten women with cervical cancer in the UK is diagnosed over the age of 75. Globally, recommendations for cervical screening exist in 139/202 countries. Of these, 48 currently recommend hrHPV testing. Efforts must be made to encourage uptake of both screening and vaccination in order to continue to reduce rates of cervical cancer in the UK.
宫颈癌仍然是一个全球女性可预防但却十分严重的医疗保健问题。世界卫生组织（WHO）于2018年宣布呼吁消除宫颈癌，并给出了针对宫颈癌前病变的筛查、疫苗接种及治疗建议。在英国，筛查的参与率正在下降，尤其是年轻女性，其筛查率现已降至70%以下。目前，初次筛查采用高危型人乳头瘤病毒（hrHPV）检测。这项检测灵敏度高，但特异性不强，这意味着它能很好地检测出癌症或癌前病变而不漏诊，但大多数hrHPV检测呈阳性的人并不会患宫颈癌或癌前病变，因此检测呈阳性可能会导致不必要的担忧。任何病毒检测呈阳性的样本都要进行“反射”细胞学检查（即把悬浮在液体中的细胞染色，然后由经过培训能够进行此项评估的人员在显微镜下检查的过程）。这意味着只有病毒检测呈阳性的样本才会接受检测，以挑选出需要进行阴道镜检查（在专业妇科诊所使用特殊透镜观察宫颈）的患者。目前正在研究这种分流检测的其他可能性，这可能会提高筛查的准确性，包括甲基化（DNA中可测量的化学变化）检测和特定标志物检测。16型人乳头瘤病毒是全球最常见的高危毒株，在英国也不例外。英国国家疫苗接种计划始于2008年，目前在英国的接种率约为80%。自2021年起，9价重组人乳头瘤病毒疫苗（可预防7种高危型hrHPV和2种可引起尖锐湿疣的HPV）已在学校提供给12至13岁的男孩和女孩。2023年，疫苗接种与免疫联合委员会（JCVI）的新指南建议单剂量接种就足够了。HPV疫苗接种几乎消除了1995年及以后出生人群中的宫颈癌。英国筛查计划的未来方向包括自我采样、疫苗接种后时代的调整以及提高筛查的年龄上限。自我采样已被证明与临床医生采集的样本准确性相似，对于那些未参加筛查的人来说可能是个不错的选择，这些人患宫颈癌的风险更高，预后更差。在英国，每十名宫颈癌女性患者中就有一名是在75岁以上被诊断出来的。在全球范围内，202个国家中有139个国家存在宫颈癌筛查建议。其中，48个国家目前推荐hrHPV检测。必须努力鼓励人们接受筛查和疫苗接种，以便在英国继续降低宫颈癌发病率。
