子宫颈癌预防的现代策略

Modern Prevention Strategies of Cervical Cancer

子宫颈癌是女性最常见的生殖道恶性肿瘤,发病呈年轻化和上升化趋势。筛查是防治之始,中国拟行最佳、一般及基本3种方案。子宫颈上皮内瘤变(CIN)系癌前病变,可采用细胞学——阴道镜检——组织学明确病变级别,并给予规范化处理。人乳头瘤病毒(HPV)感染是子宫颈癌发生的基本因素,持续的高危型HPV感染可引发子宫颈病变及子宫颈癌。HPV检测可用于筛查、未明确诊断意义的不典型鳞状上皮细胞/鳞状上皮内低度病变(ASC-US/LSIL)分流及治疗后随诊。对HPV感染的现代对策是"治病——治疗CIN,即治毒——HPV"。HPV疫苗的问世是预防子宫颈癌的重要事件,可形成一级预防。但早诊早治仍是最基本的防治策略。

Cervical cancer is the most common malignancy of the female genital tract. Its incidence is still increasing with lower average onset age. Mass screening should be above prevention and treatment, and three screening programs, including the optimal program, the general program, and the basic program, are currently adopted in China. Cervical intraepithelial neoplasia （CIN） , a precancerous lesion, can be confirmed by the combined use of cytology, colposcopy, and histology and then managed with standardized approach. Human papillomavirus （HPV） infection is an essential factor during the development of cervical cancer, and persistent infection of high-risk HPVs may lead to CIN and subsequently develop to cervical cancer. High-risk HPV detection can be used for screening, differentiation of the atypical squamous cells of undetermined significance/lowgrade squamous intraepithelial lesion （ASCUS/LSIL） triage, and follow-up after treatment. The modern strategy of HPV infection is ＂to treat the disease, CIN, means to treat the virus, HPV＂. The licensing of HPV vaccine is an important event in cancer prevention, and this vaccine can be used for the primary prevention. However, early diagnosis and early treatment are still the most basic strategies for cervical cancer prevention and treatment.