子宮頸がんのスクリーニング
Is it safe to extend the screening interval to 5 years or more after a negative screening result? A new study shows that the risk of cervical cancer after one or more combined HPV tests and cytology screening results is negative Is significantly reduced. The study found a follow-up analysis of 1 million female subjects. The analysis showed that the risk of invasive 子宮頸癌 and cervical CIN3 lesions decreased with each round of combined testing and screening. This risk reduction is most significant between the first and second rounds, and is more significant than the second and third rounds. (Ann Intern Med. November 27, 2017 online version)
Cervical cancer screening guidelines have been changing, especially with the HPV vaccine. The 2015 edition of the ACOG guidelines recommends that HPV testing can be used as an alternative screening method for women over 25 years of age. It is recommended to receive cytology every 3 years. It is also pointed out that combined cytology and HPV testing are more preferred. The USPSTF draft guideline recommends testing only HPV high-risk subtypes. As an alternative to simple cytology for women over 30, joint testing is no longer recommended.
研究者らは、HPV検査の有効性に関する研究証拠はあまりなく、公表されているHPV検査スクリーニング研究のほとんどは一連のスクリーニングに基づいていると指摘した。 研究者らは、990013年から2003年までに共同検査を受けた女性2014万XNUMX人を対象に、連続した共同検査の結果が陰性となった後の子宮頸がんリスクの変化を分析した。
The analysis found that as the negative result of the combined test increased, the risk of cervical cancer and ≥CIN3 lesions continued to decrease, and the negative effect of the first combined test had the greatest impact on risk reduction. In any round of screening, the effect of pure HPV test results on the risk of cancer is consistent, regardless of the cytological test results, regardless of the combined test results. Those who were negative for the first HPV test had a 5-year reduction in invasive cervical cancer risk of 0.0092%, and those who had a negative third test result had a 0.0015% reduction in risk; 3-year risk for invasive cervical cancer was negative for the first and third tests Decrease by 0.0081% and 0.0015%. The three-year negative cytological risk of cancer was reduced by 0.0140% and 0.0023%, respectively.
研究者は、最初の共同検査でHPV検査が陰性だった女性は、複合検査が陰性だった女性よりもがんのリスクがわずかに高いだけであり、XNUMX回目の複合検査でHPV検査が陰性だった女性のがんリスクはさらに低下したことがこの研究で示されたとコメントした。 XNUMX回目 XNUMX回目のマイナス以降は基本的になくなりました。 CIN3 病変の検出において、HPV 検査と比較した併用検査の利点は非常にわずかです。 共同検査では、不必要なコルポスコピーと生検、そして過剰な治療が追加されただけでした。
