甲状腺癌育龄期妇女筛查的必要性和可行性研究进展

Research progress on the necessity and feasibility of thyroid cancer screening for women of childbearing age

从甲状腺癌的流行状况入手,从女性生殖角度分析在育龄期妇女中进行甲状腺癌筛查的必要性和可行性。以“甲状腺癌、女性生殖、妊娠、妇女保健、流行病学”为关键词,检索PubMed、CNKI数据库中的相关文献,检索起始时间为2017-01-01-2022-09-30。纳入标准:(1)甲状腺癌流行状况及特点;(2)甲状腺癌对女性生殖的影响;(3)甲状腺癌的筛查与诊治方法。剔除标准:(1)年份较远的综述类文献;(2)质量较差、语序较乱的文献。最终纳入52篇文献。通过文献复习,总结甲状腺癌的流行病学特点,并从生殖角度分析甲状腺癌的危害;另外,基于目前甲状腺癌筛查、诊断和治疗的现状,论证将甲状腺癌纳入妇女保健工作中普癌筛查的必要性和可行性。结果显示,根据现有流行病学数据,甲状腺癌在全球范围内发病率呈上升趋势,而育龄期妇女发病率高于其他人群,提示可能与女性性激素有关。从生殖角度来看,甲状腺癌与女性不孕不育、不良妊娠结局关系密切;育龄期妇女在妊娠、哺乳这一特殊生理阶段,由于体内激素水平变化,可能诱发和加重甲状腺癌。目前,国际国内针对甲状腺癌相继更新了相关指南和专家共识,从更新的指南文献看,甲状腺癌的筛查、诊断方法可靠易行,治疗规范安全,为该病的早期筛查和治疗提供了基础。以上提示,甲状腺癌流行状况不容乐观,且其对育龄期女性身心健康、生育能力均会造成巨大影响,将甲状腺癌筛查纳入育龄期妇女保健工作符合“健康中国”医疗策略,并且基于我国当前妇幼卫生服务体系,该方案也确实可行。

Starting with the prevalence of thyroid cancer,the necessity and feasibility of thyroid cancer screening among women of childbearing age were analyzed from the perspective of female reproduction."Thyroid cancer,female reproduction,pregnancy,women’s health,epidemiology"were used as the key words to search the relevant literature in PubMed and CNKI database from 2017-01-01 to 2022-09-30.Inclusion criteria:(1)prevalence and characteristics of thyroid cancer;(2)the impact of thyroid cancer on female reproduction;(3)screening,diagnosis and treatment of thyroid cancer.Exclusion criteria:(1)review literature with a long history;(2)literature with poor quality and disordered word order.A total of 52 articles were included.Through literature review,the epidemiological characteristics of thyroid cancer were summarized,and the harm of thyroid cancer from the perspective of reproduction was analyzed.In addition,based on the current status of thyroid cancer screening,diagnosis and treatment,the necessity and feasibility of incorporating thyroid cancer into universal cancer screening in women’s health care was demonstrated.According to epidemiological data,the incidence of thyroid cancer is high in childbearing age.From the reproductive point of view,thyroid cancer is closely related to female infertility and adverse pregnancy outcomes.During the special physiological stage of pregnancy and lactation,due to changes in hormone levels in the body,thyroid cancer may be induced and aggravated.At present,relevant guidelines and expert consensus for thyroid cancer have been developed in China and abroad.The screening and diagnosis methods of thyroid cancer are reliable,easy,and the treatment is standardized and safe,which provides a basis for early screening and treatment of thyroid cancer.Thyroid cancer screening should be carried out with breast cancer and cervical cancer screening policies.Combined with the existing maternal and child health service system,this program is feasible.