科研之友
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摘要
The aim of the guideline was to provide global resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer, while accounting for wide variations in resource levels and health systems. These are the first cervical cancer screening guidelines that offer recommendations tailored to resource availability in the settings where women live. The Society's guideline was developed by a multidisciplinary, multinational panel of oncology, primary care, epidemiology, health economic, cancer control, public health, and patient advocacy experts to produce recommendations reflecting different resource-tiered settings. The panel outlined minimum standards for cervical cancer screening based on resources available in 4 distinct types of health care settings: basic, limited, enhanced, and maximal. The panel reviewed existing guidelines and conducted a formal consensus-based process and a modified ADAPTE process to adapt existing guidelines. Adapted recommendations from 7 existing guidelines form the evidence base. Indirect evidence to inform consensus was provided by 4 systematic reviews plus cost-effectiveness analyses and resulted in 75% agreement of greater. For primary screening, human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. The recommended age ranges for screening and frequency are as follows. In the maximal setting, ages 25 to 65 years every 5 years. In the enhanced setting, women aged 30 to 65 years every 5 years, and with 2 consecutive negative test results at 5-year intervals, every 10 years. In the limited setting, ages 30 to 49 years every 10 years, and in the basic setting, ages 30 to 49 years 1 to 3 times per lifetime. Triage of screening results In basic settings, visual assessment is recommended as triage; for other settings, HPV genotyping and/or cytology may be used. For negative triage results, follow-up in 12 months is recommended. After triage In basic settings, treatment is recommended for women with abnormal triage results; for other settings, colposcopy is recommended if triage results are abnormal. Treatment of precursor lesions In basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure; in other settings, loop electrosurgical excision procedure (or ablation) is recommended. In all settings, 12-month posttreatment follow-up is recommended. Time to end screening For maximal and enhanced settings, older than 65 years with consistently negative results during more than the past 15 years; in limited and basic settings, younger than 49 years. Special populations For human immunodeficiency virus-positive women, screening with HPV testing as soon as diagnosed and screening twice as many times per lifetime as the general population. After delivery in basic settings, screening at 6 weeks postpartum; for other settings, screening at 6 months. For basic settings without mass screening, infrastructure should be developed for HPV testing, diagnosis, and treatment. Health care system decision makers and health care providers should be guided by the recommendations for the highest stratum of resources available. The guidelines are intended to complement, not replace, local guidelines.
- 出版日期2017-5
