Cytological screening for cervical cancer prevention
Cytological screening for cervical cancer prevention
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DOI：
10.1016/j.bpobgyn.2011.08.001
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发表时间：
2012-04-01
影响因子：
5.5
通讯作者：
Denny, Lynette
中科院分区：
文献类型：
--
作者：
Denny, Lynette
从历史上看，宫颈癌的发病率和死亡率在那些建立和维持大规模组织的细胞学筛查计划的国家有所下降。然而，这些方案需要经常重复进行筛选测试。它们还需要一个运作良好的保健基础设施，包括涂片处理和判读实验室、质量控制机制、阴道镜检查转诊、前驱体治疗以及发现治疗失败的后续行动。虽然这种方法在正确实施的情况下成功地预防了宫颈癌，但对于发展中国家来说，它被证明是非常复杂和昂贵的。因此，贫穷国家没有建立成功的筛查方案，宫颈癌仍然是发展中国家妇女中最常见的癌症，尽管存在细胞学检查和宫颈癌预防知识。新技术，特别是液基细胞学的发展，改善了细胞学作为筛查测试的性能，但没有克服基于细胞学的筛查方案对卫生系统构成的基础设施挑战。在本章中，细胞学筛查的历史和二级预防策略所带来的挑战进行了审查。(C)2011爱思唯尔有限公司保留所有权利。
Historically, the incidence and mortality of cervical cancer has declined in countries that have instituted and sustained mass-organised cytology-based screening programmes. These programmes, however, required frequent repeats of the screening tests. They also require a functioning healthcare infrastructure, with laboratories for smear processing and interpretation, mechanisms for quality control, referral for colposcopy, treatment of precursors, and follow-up to detect failures of treatment. Although this approach has been successful in preventing cervical cancer where implemented correctly, it has proved inordinately complex and expensive for developing countries. Consequently, no successful screening programmes have been established in poor countries, and cervical cancer remains the most common cancer among women in developing countries, despite the existence of cytology and the knowledge of cervical cancer prevention. New technologies, specifically the development of liquid-based cytology, have improved the performance of cytology as a screening test, but do not obviate the infrastructural challenges posed to health systems by cytology-based screening programmes. In this chapter, the history of cytological screening and the challenges posed by secondary prevention strategies are reviewed. (C) 2011 Elsevier Ltd. All rights reserved.