美国女性宫颈抹片筛查的方式趋于合理

美国疾病预防控制中心(CDC)的最新报告显示，年龄≤30岁的美国女性正越来越多地以符合循证建议的方式接受宫颈癌筛查(MMWR 2013;61:1038-42)。

2012年，美国妇产科医师协会(ACOG)、美国癌症学会(ACS)和美国预防服务工作组(PSTF)共同提出建议，呼吁不要早于21岁开始宫颈抹片筛查，22~30岁女性接受间隔3年的常规宫颈抹片筛查。

Saraiya博士及其同事从行为危险因素监测系统(BRFSS)中采集了18岁以上成人的电话调查数据。在2000~2010年间，共有125,297名女性回答了“你是否曾接受宫颈抹片检查？”这一问题。本项分析旨在了解2012年指南发布前美国女性接受宫颈抹片筛查情况的变化趋势。

结果显示，在这10年间，18~21岁女性中自称从未接受筛查者所占比例由26.3%增至47.5%，在此前1年内曾接受宫颈抹片检查者所占比例由65%降至41.5%。在22~30岁女性中，报告在此前1年内曾接受宫颈抹片检查者所占比例由78.1%降至67%。然而不尽人意的是，22~30岁女性中从未接受筛查者的比例也出现了增高，由6.6%增至9%。CDC流行病学与应用研究部的医学官Mona Saraiya博士报告称：“我们需要更努力地推广最新的循证建议，使宫颈癌筛查的获益最大化。”

研究者承认这项调查存在一些局限性，包括数据来自受访者报告，未考虑受访者接受宫颈抹片筛查的行为是否受到人乳头状瘤病毒(HPV)免疫状态、开始性生活的时间等因素的影响。

在同期另一项基于BRFSS数据的研究中，CDC的Meg Watson硕士及其同事发现，在年龄≥30岁、已接受子宫切除术的女性中，宫颈抹片筛查率由2000年的73.3%降至2010年的58.7%；在年龄≥65岁、未接受子宫切除术的女性中，3年内曾接受宫颈抹片筛查的比例由73.5%降至64.5%。不过，年龄30~64岁、无医疗保险、未接受子宫切除术的女性，3年内曾接受宫颈抹片筛查的比例也在下降，由2000年的74.4%降至2010年的68.7%(MMWR 2013;61:1043-7)。

研究者称：“未按照指南建议接受筛查和随访的女性，死于宫颈癌的风险更高。这项研究表明，教育程度较低、缺乏医疗保健资源、无医疗保险的女性中存在筛查不足的情况。”

这两项研究均由CDC资助。

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By: DOUG BRUNK, Oncology Practice

Women aged 30 years and younger in the United States are undergoing cervical cancer screening in line with recent national recommendations, findings from a new report from the Centers for Disease Control and Prevention demonstrated.

For example, between 2000 and 2010, the percentage of women aged 18-21 years who reported never being screened increased from 26.3% to 47.5%, while the percentage of women aged 22-30 years who reported having a Pap test within the preceding 12 months decreased from 78.1% to 67%.

However, in what researchers described as an "unfavorable trend," the prevalence of women aged 22-30 years who reported having never been screened increased from 6.6% in 2000 to 9% in 2010. "More effort is needed to promote acceptance of the latest evidence-based recommendations so that all women receive the maximal benefits of cervical cancer screening," researchers led by Dr. Mona Saraiya reported in the Jan. 4 edition of Morbidity and Mortality Weekly Report.

In 2012, recommendations from the American College of Obstetricians and Gynecologists, the American Cancer Society, and the U.S. Preventive Services Task Force called for Pap screening to begin no earlier than age 21 and within an interval of 3 years between routine Pap tests for women aged 22-30 years. The purpose of the current analysis was to evaluate trends in Pap testing before the 2012 guidelines were introduced.

Dr. Saraiya, a medical officer in the Centers for Disease Control and Prevention (CDC) Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch, and her associates collected data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey of adults aged 18 years and older (MMWR 2013;61:1038-42). Between 2000 and 2010, 125,297 female respondents in all 50 states and the District of Columbia were asked, "Have you ever had a Pap test?" The researchers analyzed Pap test status by age group, race/ethnicity, U.S. Census region, and health care coverage status.

Between 2000 and 2010, the percentage of women aged 18-21 years who reported never being screened increased from 26.3% to 47.5%, while the percentage who reported having a Pap test within the preceding 12 months decreased from 65% to 41.5%. During the same time period, the percentage of women aged 22-30 years who reported never being screened increased from 6.6% to 9.0%, while the percentage who reported having a Pap test within the preceding 12 months decreased from 78.1% to 67%.

The researchers acknowledged certain limitations of the survey, including the fact that the data were self-reported, and that it "did not consider whether Pap testing behaviors varied by human papillomavirus (HPV) vaccination status or by timing of sexual initiation."

In a separate study of BRFSS data from the same time period, CDC researchers led by Meg Watson, M.P.H., found that Pap test use among women aged 30 years and older who have had a hysterectomy decreased from 73.3% in 2000 to 58.7% in 2010, while recent Pap testing (within 3 years) decreased among women aged 65 years and older without a hysterectomy, from 73.5 % in 2000 to 64.5 % in 2010 (MMWR 2013;61:1043-7). However, women aged 30-64 years who did not have health insurance and had not had a hysterectomy were less likely to have received a Pap test within the previous 3 years – from 74.4 % in 2000 to 68.7 % in 2010.

"Women not receiving recommended screening and follow-up are at increased risk for cervical cancer mortality," the researchers noted. "Underscreening among women with less education, no usual source of health care, and no health care coverage is well documented and a persistent cause of health disparities."

Both studies were funded by the CDC.