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| 子宫颈癌筛检指引变更应符合经济效益 | |
March 4, 2008 — 研究者表示，现在我们有了疫苗与人类乳突病毒（HPV）的DNA检验，这或许是考虑变更美国子宫颈癌筛检指引的时机了。他们表示，这些治疗指引於2001年与2003年更新，那时的进展代表了变更筛检策略将会是符合经济效益的。 如同於3月5日发表於国家癌症机构期刊的报告，来自麻州波士顿哈佛公共卫生学院的Sue Goldie医师与其同事透过数学模式来预测接受或未接受疫苗接种女性不同筛检模式的影响。 该团队表示，应该对接种疫苗或未接种疫苗的女性改变策略，目前，指引建议以病理筛检，且仅在结果不确定时进行HPV DNA检验；Goldie医师与其同事表示，对21至25岁女性继续使用子宫颈病理检验以及HPV分类，对30岁以上女性则转换到HPV DNA筛检与子宫颈病理分类。 对未来20年将会接受疫苗接种的近四千万女性，研究者建议，虽然疫苗提供长期的免疫力，25岁以后的筛检频率下降（目前的建议是传统病理学方法筛检是每年进行一次，以液体细胞学检验的筛检为每二至三年一次）。 西雅图华盛顿大学的Nancy Kiviat医师与其同事在随后的主编评语中表示，这些分析无疑地支持在短暂的未来我们急需发展筛检建议；然而，他们附带表示，发展新的、在HPV疫苗领域中更适当筛检方式的生物标记，将会是发展真正符合经济效益筛选方式所必须的。 主编们表示，一个在目前研究中并未提到的考量，是越来越多人接种对抗高风险亚型HPV病毒的疫苗，检验HPV DNA的效果将会变得比筛检或分类检验差；他们指出，HPV DNA检验的阳性预测值已经不高，特别是对年轻的女性，在这种情况下，真阳性检验的绝对数目将会显著降低。他们写道，因此，必须研发其他的筛检方法。为了要达到必须的专一性，这些筛检方法将必须根据侦测与癌症生成有关的变化，而不是仅侦测HPV感染是否存在（例如侦测不同HPV基因產物）、或是侦测HPV带来的变化（例如与细胞週期控制相关的不同分子变化）。这样的检验方式将有助於找出非常年轻女性确实具有恶化高风险的高度病灶。 研究者与主编们表示没有相关资金上的往来。 Changes in Cervical Cancer Screening Guidelines Could be Cost-Effective March 4, 2008 — Now that vaccines and DNA testing for human papillomavirus (HPV) are both readily available, it might be time to reconsider changes in the guidelines for cervical cancer screening in the United States, say researchers. These guidelines were updated in 2001 and 2003, but advances made since then mean that a change in strategy would be more cost-effective, they suggest. As reported in the March 5 issue of the Journal of the National Cancer Institute, Sue Goldie, MD, from the Harvard School of Public Health in Boston, Massachusetts, and colleagues used mathematical models to predict the impact of various screening techniques in both vaccinated and unvaccinated women. The team suggests a change in strategy for both vaccinated and unvaccinated women. Currently, the guidelines recommend screening with cytology methods and using HPV DNA testing only when the results are equivocal. Dr. Goldie and colleagues suggest that it would be more cost-effective to continue screening using cervical cytology with HPV triage for women between the ages of 21 and 25 years, and then to switch to HPV DNA testing with cytology triage for women older than 30 years. For the nearly 40 million girls who are likely to be vaccinated over the next 20 years, the researchers suggest that — provided the vaccines provide long-lasting immunity — screening after the age of 25 years be less frequent. (Currently, recommendations are for yearly screening with conventional cytology methods, with screening once every 2 to 3 years using liquid-based cytology methods.) These analyses \"will undoubtedly support the urgently needed development of screening recommendations for the immediate future,\" comment Nancy Kiviat, MD, and colleagues from the University of Washington, in Seattle, in an accompanying editorial. \"However, the development of novel biomarkers that are more appropriate for screening in the era of the HPV vaccine is necessary for the development of truly cost-effective screening approaches,\" they add. One consideration not addressed in the current study, the editorialists note, is that as an increasing proportion of the population are vaccinated against an increasing number of high-risk types of HPV, testing for HPV DNA will become less useful as a screening or triage assay. HPV DNA testing already has a poor positive predictive value, especially in younger girls, they point out, and the absolute number of true positive tests would decrease substantially in this scenario. \"Thus, other screening assays will have to be developed,\" they write. \"To achieve the necessary specificity, such assays are likely to be based on the detection of changes associated with oncogenesis, rather than on the detection of HPV infection (such as the detection of various HPV gene products) or changes induced by the presence of HPV (such as changes in the various molecules associated with cell-cycle control). Such assays would also help indicate which of the high-grade lesions detected in very young women actually carry a substantial risk of progression.\" Neither the researchers nor the editorialists have disclosed any relevant financial relationships. 发布时间：2008年03月13日 |
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