[cactus1972]

Возможно, коллегам-гинекологам будет интересно

[Ссылки доступны только зарегистрированным пользователям ]

Опубликован в A Cancer Journal for Clinicians

Также текст [Ссылки доступны только зарегистрированным пользователям ] можно прочитать в мартовском выпуске Annals of Internal Medicine.

Основные положения

Age to Begin Screening
It is now recommended that cervical cancer screening begin at 21 years of age, regardless of sexual activity or other risk factors. The rationale for this recommendation is that cervical cancer is rare in adolescents and young women, and might not be prevented with cytology screening. The incidence of cervical cancer screening in this age group has not changed, even with the increased screening strategies of the past 4 decades.

Screening at 21 to 29 Years of Age
Screening with cytology is recommended every 3 years for women 21 to 29 years of age. This interval appears to provide the "best balance of benefits and harms." HPV testing should not be used as a standalone test or a cotest with cytology in this age group because of the high prevalence of HPV infection in young women.

Screening at 30 to 65 Years of Age
Women 30 to 65 years of age should be screened with both cytology and HPV testing every 5 years (preferred) or with cytology alone every 3 years (acceptable). Evidence is insufficient to support a screening interval longer than 3 years for cytology alone, even among women who have had a series of negative tests. Cotesting at 5-year intervals provides a cancer risk similar to or lower than screening with cytology alone at 3-year intervals.

Screening With HPV Alone
In most clinical settings, women should not be screened with HPV testing alone. Although HPV testing is promising, there is a "lack of a well-defined and evaluated management strategy for positive tests that precludes their practical implementation in the majority of clinical settings in the United States at this time."

Screening in Women Older Than 65 Years
When there is evidence of adequate negative previous screening and no history of cervical intraepithelial neoplasia of grade 2 or higher (CIN2+) in the previous 20 years, cervical cancer screening can be stopped in women older than 65 years. Once screening is discontinued, it should not be resumed for any reason, even if the woman has a new sexual partner. The rationale for this recommendation is that the prevalence of advanced lesions or cervical cancer is rare in women who have been adequately screened in the United States. Because the transmission of a new carcinogenic HPV infection will most likely clear on its own, the benefit of screening in this population does not outweigh potential harms.

Screening in Women With No History of CIN2+ After Hysterectomy
Women of any age who have had a hysterectomy and their cervix removed should not be screened for vaginal cancer, and evidence of adequate negative previous screening is not required. The rationale for this recommendation is that vaginal cancer is uncommon, and abnormal vaginal cytology is rarely of clinical importance.

Screening in Women After HPV Vaccination
The same screening recommendations apply to women who have and who have not received an HPV vaccination (Gardasil or Cervarix). The guidelines point out that the current vaccines do not cover all carcinogenic HPV types, and because recommendations include vaccinating women up to 26 years of age, many will receive the vaccine after they have already been exposed to HPV.