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2012年美国宫颈癌筛查新指南解读

莫小亮, 罗殿中

莫小亮, 罗殿中. 2012年美国宫颈癌筛查新指南解读[J]. 肿瘤防治研究, 2014, 41(02): 188-192. DOI: 10.3971/j.issn.1000-8578.2014.02.024
引用本文: 莫小亮, 罗殿中. 2012年美国宫颈癌筛查新指南解读[J]. 肿瘤防治研究, 2014, 41(02): 188-192. DOI: 10.3971/j.issn.1000-8578.2014.02.024
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MO Xiaoliang, LUO Dianzhong. New Insights into Cervical Cancer Screening Guidelines in the United States, 2012[J]. Cancer Research on Prevention and Treatment, 2014, 41(02): 188-192. DOI: 10.3971/j.issn.1000-8578.2014.02.024
Citation: MO Xiaoliang, LUO Dianzhong. New Insights into Cervical Cancer Screening Guidelines in the United States, 2012[J]. Cancer Research on Prevention and Treatment, 2014, 41(02): 188-192. DOI: 10.3971/j.issn.1000-8578.2014.02.024
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2012年美国宫颈癌筛查新指南解读

  • 1. 530021南宁，广西医科大学第一附属医院妇产科，2.病理科

基金项目: 广西壮族自治区卫生厅自筹经费科研课题(Z2013013)；广西研究生教育创新计划资助项目（YCBZ2013015）；广西自然科学基金 (2013GXNSFAA019254)
详细信息
    作者简介:

    莫小亮（1980-），女，博士在读，主治医师，主要从事宫颈癌分子生物学方面的研究

  • 中图分类号: R737.33

New Insights into Cervical Cancer Screening Guidelines in the United States, 2012

  • 1.Department of Obstetric and Gynecology,The First Affi liated Hospital of Guangxi Medical University, Nanning 530021, China,2.Department of Pathology

摘要

    摘要
  • 摘要: 本文就2012年ACOG、ACS/ASCCP/ASCP指南中宫颈癌筛查的新建议及相关证据进行解读，并对宫颈癌筛查的新标志物、HPV检测新技术和未来可能的宫颈癌筛查新策略进行综述。2012年宫颈癌筛查新指南建议，宫颈癌筛查应从21岁开始，无论性生活开始的年龄或是否有其他行为相关的危险因素，对21岁以前的人群不应进行筛查。新指南还延长了细胞学检查的时间间隔：21~29岁的妇女细胞学检查间隔时间由过去的2年延长至3年，在30~65岁无高危因素的妇女中若HPV联合细胞学两项检查均为阴性可将筛查间隔时间延长至5年，并将终止筛查的年龄提前至65岁，因良性病变（无宫颈CIN2+或宫颈癌病史）而行子宫切除术的妇女不需要再进行筛查。但已接种疫苗妇女仍需继续同未接种疫苗的妇女一样按照指南进行宫颈癌筛查。最新的指南中将HPV联合细胞学检查作为30岁以上妇女的最佳筛查策略，并建议将HPV16、18分型检测作为分流HPV检测阳性而细胞学阴性患者的标准。HPVE6/E7mRNA、p16和Ki-67等新标志物的检测可能成为HPV检测阳性而细胞学检查阴性的患者进行分流管理的新生物学指标，并使筛查策略得到优化。

     

    Abstract: With knowledge of the pathogenesis of cervical cancer in the last decade, we are always improving the strategy for cervical cancer screening. Both of ACS/ASCCP/ASCP group and the USPSTF and ACOG released their new guidelines in 2012. We review these recommendations and the possible future direction of screening.In their guidelines for cervical cancer screening in 2012, several organizations call for less frequent but more effective screening which incorporates testing for human papillomavirus (HPV). The new guidelines still recommend starting screening with cytologic (Papanicolaou) testing at age 21, but with longer screening intervals, women with age 21 to 29 are recommended screening every 3 rather than 2 years, and women with age 30 and older screened by combined cytologic and HPV testing should be rescreened every 5 years if both test results are negative. The new guidelines recommend stopping screening in advance at age 65 if they have had adequate screening until then with no history of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in the past 20 years. The new guidelines now recommend HPV 16/18 genotyping as a triage option in women who have positive results on HPV testing but negative cytology results, and immediate referral for colposcopy if the genotyping test is positive. It can help to identify those at higher risk of developing CIN2+. They reaffi rm their recommendation about stopping screening after hysterectomy with removal of the cervix for a reason except who have had history of CIN2+ or cervical cancer. Screening should not be changed after HPV vaccination. Combined cytologic and HPV testing has received its strongest endorsement to date in their latest guidelines. And the novel biomarkers such as p16 and Ki-67 expression has been found helpful for clinician in deciding which women who have positive HPV but negative cytology results should be referred for colposcopy. With the latest cervical cancer screening guidelines, we can implement a more sensitive and effective screening strategy for better prevention and early detection of cervical cancer.

     

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出版历程
  • 收稿日期:  2013-06-02
  • 修回日期:  2013-10-24
  • 刊出日期:  2014-02-24

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