美国宫颈癌筛查飞指南final.pptVIP

子宫切除术后人群的筛查 如无CIN2+病史可退出常规筛查 原发性阴道癌罕见（0.69/10万） 阴道残端细胞学阳性率约为1~3%，PPV很低 长期随诊VAIN检出率很低，浸润癌更少 疫苗接种人群的筛查 同未接种人群 目前美国疫苗接种率仅30%，群体免疫效果尚未显现 现有的HPV疫苗尚不能覆盖所有致瘤型HPV HPV疫苗对子宫颈癌的保护效果需要20–30 年的时间才可以看出来 即使疫苗有很好的保护作用，筛查及很好的组织管理仍是必要的 结 论 筛查必须平衡利弊 筛查和筛查后的随访原则应当基于患病的风险 企图完美预防宫颈癌是难以实现的，若把努力都放在追求完美的筛查敏感性，有害无益 美国若增加对未筛查人群的覆盖，将会降低50%的宫颈癌发病率，我国亦然。 Thank you ！ * * * * * The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up (eg, the management of screen positives and screening intervals for screen negatives) of women after screening, the age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16 and HPV18 infections. These guidelines were developed to address cervical cancer screening in the general population. These guidelines do not address special, high-risk populations who may need more intensive or alternative screening. These special populations include women (1) with a history of cervical cancer; (2) who were exposed in utero to diethylstilbestrol (DES); and (3) who are immunocompromised (eg, infection with the human immunodeficiency virus). * * One of the most important conclusions from the meeting was that there were no data to support screening of adolescent women (G21 y old). Importantly, one of the participating organizations, the American College of Obstetrics and Gynecology (ACOG), now recommends that cervical cancer screening begins at age 21, rather than the previous recommendation to begin screening within 3 years of beginning sexual activity or at age 21 (whichever is younger) . The annual incidence of cervical cancer in adolescent women was approximately 1 to 2 cases per 1 million women at all time points since 1973. There is a lack of evidence that early screening women up to the age of 25 years prevents cervical cancer at these ages [