Risk Assessment to Guide the Prevention of Cervical Cancer
Risk Assessment to Guide the Prevention of Cervical Cancer
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DOI：
10.1097/lgt.0b013e31815ea58b
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发表时间：
2008-01-01
影响因子：
3.7
通讯作者：
Schiffman, Mark
中科院分区：
文献类型：
--
作者：
Castle, Philip E.;Sideri, Mario;Schiffman, Mark
筛查和诊断的进步使预防宫颈癌变得越来越可能。然而，如果被滥用或理解不足，这些新工具只会增加成本，并可能对患者造成伤害，而不会带来好处。作为标准化护理的框架，最大限度地提高患者的安全和福祉，我们建议采用风险模型来指导现在和将来的临床管理。该模型将使用宫颈癌前病变和可治疗癌症风险增加的阈值来指导筛查强度、诊断评估或治疗的临床决策。专家将基于患者风险受益来决定这些风险阈值和分层，而不依赖于当前（例如，细胞学、致癌性人乳头瘤病毒检测和阴道镜检查）以及未来测量风险的方法。预防子宫颈癌的风险管理模式，基于与风险层相对应的适当临床行动，可以更好地分配资源，提高风险最大妇女的安全性，并提高风险最低妇女的福祉。
Advances in screening and diagnosis make it increasingly possible to prevent cervical cancer. However, if misused or poorly understood, these new tools will only increase costs and potentially harm patients without benefit. As a framework for standardized care that maximizes patient safety and well-being, we propose that a risk model be adopted to guide clinical management now and in the future. The model would use thresholds of increasing risk for cervical precancer and treatable cancer to guide clinical decision making for screening intensity, diagnostic evaluation, or treatment. Experts would decide on these risk thresholds and stratum based on the patient risk to benefit, independent of current (e.g., cytology, carcinogenic human papillomavirus testing, and colposcopy) and future methods of measuring risk. A risk management model for cervical cancer prevention, based on appropriate clinical actions that correspond to risk stratum, can result in better allocation of resources to and increased safety for women at the greatest risk and increased well-being for women at the lowest risk.