宫颈癌早期筛查及检测新策略

New Strategies for Early Screening and Detection of Cervical Cancer

摘要: 在过去的几十年里，美国在基于人群的广泛筛查发现，宫颈癌发病率和死亡率的显著下降。尽管取得了这样的筛查结果，但据估计2018年有13,240名美国女性被诊断出宫颈癌，并有4170人死于宫颈癌。大量一致的证据表明，感染高危型人乳头瘤病毒(hrHPV)是宫颈癌的病原体。这些感染很常见，发生在大多数性生活活跃的女性一生中。虽然大多数感染在几年的时间内都没有临床后果，但持续性感染可导致高级别宫颈癌前病变(如宫颈上皮内瘤变[CIN] 2级和3级)，并可发展为宫颈癌。大约30%的CIN 3级病变在30年内进展为侵袭性癌症。这种缓慢的进展为这些病变的发现和治疗提供了许多机会，从而破坏了癌症的发展轨迹。本篇综述着重讨论宫颈癌的早期筛查以及检测的新策略。

Abstract: Over the past few decades, extensive population-based screening in the United States has found significant declines in cervical cancer incidence and mortality. Despite the screening results, an estimated 13,240 US women were diagnosed with cervical cancer in 2018 and 4170 died of it. There is a large body of consistent evidence that human papillomavirus (hrHPV) infection is the causative agent of cervical cancer. These infections are common and occur in the lifetime of most sexually active women. Although most infections have no clinical consequences over a period of several years, persistent infections can lead to high-grade precancerous lesions (such as cervical intraepithelial neoplasia [CIN 2 and CIN 3]) that can progress to cervical cancer. About 30% of CIN III lesions develop into invasive cancers within 30 years. This slow progression offers many opportunities for discovery and treatment of these lesions, thus disrupting the cancer’s trajectory. This review focuses on the early screening of cervical cancer and new strategies for detection.