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首页> 美国卫生研究院文献>World Journal of Clinical Oncology >Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices
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Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices

机译：处于十字路口的发展中国家宫颈癌筛查：新兴技术和政策选择

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Cervical cancer (CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas, the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies, researchers have attempted to find new strategies that are adapted to low- and middle-income countries (LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus (HPV) testing is more effective than cytology for CC screening. Therefore, highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages, HPV-based screening has a low positive predictive value for CC, so that HPV-positive women need to be triaged with further testing to determine optimal management. Visual inspection tests, cytology and novel biomarkers are some options. In this review, we provide an overview of current and emerging screening approaches for CC. In particular, we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care (POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress, but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.
机译：宫颈癌（CC）是影响全世界女性的第四大最常见的恶性肿瘤，也是发展中地区第二大最常见的恶性肿瘤。在这些地区，由于难以实施基于细胞学的筛查计划，因此疾病负担仍然很重要。这些国家固有的主要障碍是贫穷，缺乏医疗基础设施和训练有素的从业人员。随着新技术的普及，研究人员试图找到适合低收入和中等收入国家（LMIC）的新策略，以促进子宫颈病理的早期诊断。当前证据表明，人乳头瘤病毒（HPV）测试比细胞学更有效地进行CC筛查。因此，现在已经开发出用于初级筛选的高灵敏度测试。用于检测HPV DNA的快速分子方法直到最近才可商业获得。这是在资源贫乏地区进行CC筛查的一个里程碑，因为它可以帮助克服以前的筛查计划固有的绝大多数障碍。尽管有许多优点，基于HPV的筛查对CC的阳性预测价值较低，因此，需要对HPV阳性的妇女进行进一步的检查，以确定最佳治疗方法。目测检查，细胞学检查和新型生物标志物是一些选择。在本文中，我们概述了CC的当前和新兴筛查方法。特别是，我们讨论了实施适用于LMIC的高效宫颈筛查所面临的挑战，以及利用即时医疗（POC）HPV检测的机会引入基于HPV的主要筛查的机会。最适合LMIC的筛查策略仍在研究中，但是我们有理由相信POC HPV检测将成为未来策略的一部分，而分类检测仍需要定义。

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