简介:HPV and cervical cancer screening guideline (2020)

大多数HPV感染者可在半年内通过自身免疫系统清除病毒感染。只有10%-15%的人群因持续感染高危型HPV病毒,有可能发展为宫颈癌。已知的与女性生殖道感染相关的HPV病毒有130多种亚型,目前已经确定的有15种高危HPV病毒与宫颈癌相关,其中两种感染率最高且致病风险最高的亚型为——HPV 16和HPV 18,被证实可导致约70%的宫颈癌。和其他癌症一样,宫颈癌早期及癌前病变阶段没有明显的临床表现,定期筛查、早发现早治疗尤为重要。

  • HPV病毒亚型与其对应的疾病症状:

  • HPV感染细胞检测结果分级:

  • 医学神刊CA上发表的最新的宫颈癌筛查指南解读:

Abstract: The American Cancer Society (ACS) recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years (preferred); if primary HPV testing is not available, then individuals aged 25 to 65 years should be screened with cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years (acceptable) (strong recommendation). The ACS recommends that individuals aged >65 years who have no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, and who have documented adequate negative prior screening in the prior 10 years, discontinue all cervical cancer screening (qualified recommendation). These new screening recommendations differ in 4 important respects compared with the 2012 recommendations: 1) The preferred screening strategy is primary HPV testing every 5 years, with cotesting and cytology alone acceptable where access to US Food and Drug Administration-approved primary HPV testing is not yet available; 2) the recommended age to start screening is 25 years rather than 21 years; 3) primary HPV testing, as well as cotesting or cytology alone when primary testing is not avail-able, is recommended starting at age 25 years rather than age 30 years; and 4) the guideline is transitional, ie, options for screening with cotesting or cytology alone are provided but should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers. Evidence related to other relevant issues was reviewed, and no changes were made to recommendations for screening intervals, age or criteria for screening cessation, screening based on vaccination status, or screening after hysterectomy. Follow-up for individuals who screen positive for HPV and/or cytology should be in accordance with the 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. CA Cancer J Clin 2020;0:1-26. © 2020 American Cancer Society.

新发指南建议所有25岁~65岁的女性每5年做一次高危型HPV筛查(primary HPV testing),没有此项检查的国家的女性建议每5年做一次HPV病毒检测和细胞学检测(cotesting),如果仅做细胞学单一检测则应该每3年做一次。年龄超过65岁的女性,在近25年里细胞学检测结果从未出现CIN2级或更严重的病变,或者近10年内检测结果阴性,则无需再做定期检测。

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