Management algorithms for cervical cancer screening and precancer treatment for resource-limited settings
Management algorithms for cervical cancer screening and precancer treatment for resource-limited settings
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DOI：
10.1002/ijgo.12183
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发表时间：
2017-07-01
影响因子：
3.8
通讯作者：
Sankaranarayanan, Rengaswamy
中科院分区：
文献类型：
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作者：
Basu, Partha;Meheus, Filip;Sankaranarayanan, Rengaswamy
近年来，宫颈癌预防计划中筛查阳性妇女的管理算法发生了重大变化。世卫组织强烈建议进行人乳头瘤病毒（HPV）检测进行初步筛查，如果负担得起，或者如果负担不起，则使用醋酸（VIA）进行目视检查，并通过筛查和治疗方法（一次或两次诊所访问）直接促进筛查后的治疗。虽然VIA阳性妇女可以根据某些资格标准立即进行消融治疗，但HPV阳性妇女需要接受随后的VIA以确定其资格。更简单的消融治疗方法，如冷冻疗法和热凝固，已被证明是有效的，并具有良好的安全性，这些已成为新的管理算法的组成部分。低资源国家面临的挑战很多，从管理的角度来看，包括确定负担得起的护理点HPV检测测试，尽量减少过度治疗，并安装有效的信息系统，以确保治疗和随访的高依从性。
Management algorithms for screen-positive women in cervical cancer prevention programs have undergone substantial changes in recent years. The WHO strongly recommends human papillomavirus (HPV) testing for primary screening, if affordable, or if not, then visual inspection with acetic acid (VIA), and promotes treatment directly following screening through the screen-and-treat approach (one or two clinic visits). While VIA-positive women can be offered immediate ablative treatment based on certain eligibility criteria, HPV-positive women need to undergo subsequent VIA to determine their eligibility. Simpler ablative methods of treatment such as cryotherapy and thermal coagulation have been demonstrated to be effective and to have excellent safety profiles, and these have become integral parts of new management algorithms. The challenges faced by low-resource countries are many and include, from the management perspective, identifying an affordable point-of-care HPV detection test, minimizing over-treatment, and installing an effective information system to ensure high compliance to treatment and follow-up.