van Ballegooijen M, van den Akker-van Marle M E, Warmerdam P G, Meijer C J, Walboomers J M, Habbema J D
Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
Br J Cancer. 1997;76(5):651-7. doi: 10.1038/bjc.1997.440.
Human papillomavirus (HPV) is the main risk factor for invasive cervical cancer. High risk ratios are found in cross-sectional data on HPV prevalence. The question raised is whether this present evidence is sufficient for making firm recommendations on HPV screening. A validated cervical cancer screening model was extended by adding HPV infection as a possible precursor of cervical intraepithelial neoplasia (CIN). Two widely different model quantifications were constructed so that both were compatible with the observed HPV risk ratios. One model assumed a much longer duration of HPV infection before progressing to CIN and a higher sensitivity of the HPV test than the other. In one version of the model, the calculated mortality reduction from HPV screening was higher and the (cost-)effectiveness was much better than for Pap smear screening. In the other version, outcomes were the opposite, although the cost-effectiveness of the combined HPV + cytology test was close to that of Pap smear screening. Although small follow-up studies and studies with limited strength of design suggest that HPV testing may well improve cervical cancer screening, only large longitudinal screening studies on the association between HPV infection and the development of neoplasias can give outcomes that would enable a firm conclusion to be made on the (cost-)effectiveness of HPV screening. Prospective studies should address women aged 30-60 years.
人乳头瘤病毒（HPV）是浸润性宫颈癌的主要危险因素。在HPV流行率的横断面数据中发现了高风险比率。由此提出的问题是，目前的这些证据是否足以就HPV筛查给出确凿的建议。通过将HPV感染作为宫颈上皮内瘤变（CIN）的一种可能前驱因素加入，对一个经过验证的宫颈癌筛查模型进行了扩展。构建了两种差异很大的模型量化方法，以便二者都与观察到的HPV风险比率相符。一种模型假定HPV感染进展到CIN之前的持续时间要长得多，且HPV检测的灵敏度高于另一种模型。在该模型的一个版本中，计算得出的HPV筛查导致的死亡率降低幅度更高，（成本）效益也比巴氏涂片筛查好得多。在另一个版本中，结果则相反，尽管HPV + 细胞学联合检测的成本效益与巴氏涂片筛查相近。尽管小型随访研究以及设计力度有限的研究表明HPV检测很可能会改善宫颈癌筛查，但只有关于HPV感染与瘤变发展之间关联的大型纵向筛查研究才能得出能够就HPV筛查的（成本）效益给出确凿结论的结果。前瞻性研究应针对30至60岁的女性。
