Optimising future cervical screening strategies

Henry Kitchener
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引用次数: 7

Abstract

The switch from primary cytology to primary high risk papillomavirus (HR-HPV) testing for cervical screening is now being implemented in a number of countries. The advantages of this are to increase screening sensitivity which will save lives, and at the same time to extend screening intervals. The challenge with HR-HPV testing is its relatively poor specificity which means identifying a large number of women who are HR-HPV positive with negative cytology. One way of tackling this is to use early recall, in order to select referral to colposcopy to those women who do not clear the virus over a period of 1-2 years, as done in the recently published English Pilot Study. Another challenge in optimising screening is to recognise that wide coverage with prophylactic vaccination will require fewer screens over the lifetime of vaccinated women to maintain cost-effectiveness. HR-HPV testing allows self sampling which could both encourage more women to be screened and be more convenient for those who do wish to be screened. Cervical cancer prevention which combines vaccination and screening now offers a future in which cervical cancer could become a rarity, but efficient strategies need to be implemented.

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优化日后子宫颈普查策略
目前,一些国家正在实施从宫颈筛查的初级细胞学检测到初级高危乳头瘤病毒(HR-HPV)检测的转变。这样做的好处是提高了筛查的灵敏度,从而挽救了生命,同时延长了筛查间隔。HR-HPV检测的挑战在于其特异性相对较差,这意味着要识别出大量HR-HPV阳性但细胞学阴性的妇女。解决这个问题的一种方法是使用早期回忆,以便选择那些在1-2年内没有清除病毒的妇女进行阴道镜检查,正如最近发表的英国试点研究所做的那样。优化筛查的另一个挑战是认识到广泛覆盖预防性疫苗接种将需要在接种疫苗的妇女一生中减少筛查,以保持成本效益。人乳头瘤病毒检测允许自我抽样,这既可以鼓励更多的妇女接受筛查,也对那些希望接受筛查的妇女更方便。子宫颈癌预防结合了疫苗接种和筛检,未来子宫颈癌可能变得罕见,但需要实施有效的策略。
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来源期刊
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审稿时长
14 weeks
期刊介绍: The official Journal of the International Papillomavirus Society Papillomavirus Research (PVR), the Journal of HPV and other Small DNA Tumor Viruses publishes innovative papers related to all aspects of papillomaviruses and other small DNA tumor viruses. The official journal of the International Papillomavirus Society, PVR is an open access publication that aims to bring together virologists, immunologists, epidemiologists and clinicians working in the booming field of HPV and animal papillomaviruses, polyomaviruses and other small DNA tumor viruses and their associated diseases, in order to foster and facilitate interdisciplinary communication. The journal welcomes original research articles, reviews, short communications, opinion articles and regional update reports on papillomaviruses and other tumor viruses in the following sections: a. Biology of papillomaviruses and related viruses from life cycle to cancer b. Epidemiology etiology and natural history studies c. Natural and induced immunity including vaccine research d. Intervention studies and strategies including i. Clinical studies and trials ii. HPV treatments iii. HPV vaccination programs iv. Diagnostics and screening e. Infection and disease prevention, modeling studies f. Guidelines and public health recommendations g. HPV Studies in special populations Regional and local studies on these viruses.
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