子宫颈癌筛查大样本数据引发的思考

Insights and thinking from big data of cervical examination and human papillomavirus test

子宫颈癌是全球女性生殖道最常见由高危型人乳头瘤病毒(high-risk human papillomavirus,hr HPV)致病的恶性肿瘤,对其病变过程筛查,能够早期发现与治疗,有效遏制其发病率和死亡率。当前的筛查方法包括细胞学检查、高危型HPV检测和联合筛查(细胞学检查+高危型HPV检测)。采取何种筛查方案,对子宫颈癌的防治极为重要。目前我国对子宫颈癌筛查方案的选择存在一些困惑和争议。针对各种筛查方案的优劣性,我们对子宫颈癌筛查中获得的大样本数据进行分析,发现细胞学能有效筛查出子宫颈癌和癌前病变,高危型HPV检测的阳性检出率较高,在部分正常人群中亦可检出HPV阳性,且检测出HPV的不同型别可为临床分类管理患者和疫苗研发提供参考依据。而按筛查效果分析,细胞学联合高危型HPV检测仍是目前最佳的筛查方案。

Cervical cancer is the most common malignant tumor among women caused by high-risk human papillomavirus （hrHPV）. Its precursor lesions can be early detected through the screening procedures and treated to reduce its morbidity and mortality. There are three screening methods including a cytological examination, hrHPV test and the combination of cytological examination and hrHPV test. An appropriate screening method is important for prevention and management of the cervical cancer. It is debating for choosing which screening method of the cervical cancer in China. For this purpose, we will list the results, and provide our thinking and conclusion as the following based upon the analysis of a huge number of screening data of the cervical cancer, accumulated in the KingMed laboratory during the past years.