Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society
Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society
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DOI：
10.3322/caac.21628
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发表时间：
2020-07-30
影响因子：
254.7
通讯作者：
Smith, Robert A.
中科院分区：
文献类型：
--
作者：
Fontham, Elizabeth T. H.;Wolf, Andrew M. D.;Smith, Robert A.
美国癌症协会（ACS）建议宫颈癌患者在25岁时开始宫颈癌筛查，并每5年进行一次人乳头瘤病毒（HPV）检测，直至65岁（首选）;如果无法进行初级HPV检测，那么年龄在25到65岁之间的个体应该用联合测试进行筛查，（HPV检测与细胞学检查相结合）每5年一次或每3年一次单独进行细胞学检查（可接受）（强烈建议）。ACS建议，年龄>65岁的人，在过去25年内没有宫颈上皮内瘤变2级或更严重的疾病史，并且在过去10年内有足够的阴性既往筛查记录，停止所有宫颈癌筛查（合格建议）。与2012年的建议相比，这些新的筛查建议在4个重要方面有所不同：1）首选的筛查策略是每5年进行一次HPV初筛检测，在无法获得美国食品和药物管理局批准的HPV初筛检测的情况下，可以单独进行联合检测和细胞学检查; 2）开始筛查的推荐年龄为25岁而不是21岁; 3）初次HPV检测，以及在无法进行初次检测时单独进行联合检测或细胞学检查，建议从25岁开始，而不是30岁;四是具有过渡性，提供了联合检测或单独细胞学筛查的选择，但一旦可以完全获得用于宫颈癌筛查的初级HPV检测，隔栏.对与其他相关问题相关的证据进行了审查，未对筛选间隔、年龄或筛选停止标准、基于疫苗接种状态的筛选或子宫切除术后的筛选的建议进行变更。对HPV和/或细胞学筛查阳性的个体进行随访，应符合2019年美国阴道镜检查和宫颈病理学会关于异常宫颈癌筛查试验和癌症前兆的基于风险的管理共识指南。
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 available, 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.