nav emailalert searchbtn searchbox tablepage yinyongbenwen piczone journalimg journalInfo journalinfonormal searchdiv searchzone qikanlogo popupnotification paper paperNew
2023, 05, v.14 1-7
在低卫生资源环境下消除宫颈癌:从全球视角到中国视角
基金项目(Foundation): 腾讯公益慈善基金会(TF-20221116-00001-0001); 中国医学科学院医学与健康科技创新工程(2021-I2M-1-004)
邮箱(Email): qiaoy@cicams.ac.cn;
DOI: 10.19757/j.cnki.issn1674-7763.2023.05.001
摘要:

宫颈癌是全球性的公共卫生问题,其疾病负担分布间接反映了卫生资源分布的不公平性。世界范围内,194个国家共同承诺于2030年消除宫颈癌,并探索了不同的策略和应对措施。在我国,宫颈癌的防控体系已历经半个多世纪的建设,未来的工作重点将是如何在低卫生资源环境下消除宫颈癌。本文对宫颈癌的流行现状与我国宫颈癌的防控策略探索历程进行简要综述,并探讨了宫颈癌三级防控措施在低卫生资源环境下的应用,以提高基层诊断及管理水平,有效缓解资源有限地区因卫生医疗资源不足而造成的困境,助力我国在2030年前达到消除宫颈癌“90-70-90”的中期目标,最终消除宫颈癌。

Abstract:

Cervical cancer poses a global public health challenge, characterized by a pattern of disease burden that underscores disparities in health resource distribution. The pursuit of cervical cancer elimination in 2030 has emerged as a shared commitment among 194 nations, and various stategies have been explored globally. China has developed cervical cancer prevention system over the half century, however, there remains an imperative to eliminate cervical cancer in low medical resource areas. This article provides a succinct overview of cervical cancer epidemiology and preventive strategies in China, with a specific emphasis on tertiary prevention of cervical cancer at resource-constrained areas in order to improve diagnose and management at grass-roots unit, and effectively overcome difficulties caused by limited health resources, thereby contribute to China's aspirations of achieving the “90-70-90” midterm targets by 2030 and ultimately eliminate ocervical cancer.

参考文献

[1]Sung H,Ferlay J,Siegel RL,et al.Global cancer statistics 2020:globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2021,71(3):209-249.

[2]Bray F,Ferlay J,Soerjomataram I,et al.Global cancer statistics 2018:globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2018,68(6):394-424.

[3]Jemal A,Bray F,Center MM,et al.Global cancer statistics[J].CA Cancer J Clin,2011,61(2):69-90.

[4]World Health Organization.Human papillomavirus vaccines:WHO position paper (2022 update)[J].Wkly Epidemiol Rec,2022,97(50):645-672.

[5]De Souza JA,Hunt B,Asirwa FC,et al.Global health equity:cancer care outcome disparities in high-,middle-,and low-income countries[J].J Clin Oncol,2016,34(1):6.

[6]Falcaro M,Casta?on A,Ndlela B,et al.The effects of the national HPV vaccination programme in England,UK,on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence:a register-based observational study[J].The Lancet,2021,398(10316):2084-2092.

[7]Bosch FX,Lorincz A,Mu?oz N,et al.The causal relation between human papillomavirus and cervical cancer[J].J Clin Pathol,2002,55(4):244-265.

[8]Arbyn M,Xu L.Efficacy and safety of prophylactic HPVvaccines.A cochrane review of randomized trials[J].Expert Rev Vaccines,2018,17(12):1085-1091.

[9]Singh D,Vignat J,Lorenzoni V,et al.Global estimates of incidence and mortality of cervical cancer in 2020:a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative[J].Lancet Glob Health,2023,11(2):e197-e206.

[10]Zhao F,Qiao Y.Cervical cancer prevention in China:a key to cancer control[J].The Lancet,2019,393(10175):969-970.

[11]Ogilvie G,Nakisige C,Huh WK,et al.Optimizing secondary prevention of cervical cancer:recent advances and future challenges[J].Int J Gynaecol Obstet,2017,138(1):15-19.

[12]Saslow D,Solomon D,Lawson HW,et al.American cancer society,American society for colposcopy and cervical pathology,and American society for clinical pathology screening guidelines for the prevention and early detection of cervical cancer[J].CA Cancer J Clin,2012,62(3):147-172.

[13]Perkins RB,Guido RS,Castle PE,et al.2019 ASCCPRisk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors[J].J Low Genit Tract Dis,2020,24(2):102-131.

[14]World Health Organization.WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention,second edition:use of mrna tests for human papillomavirus (HPV)[M].Geneva:World Health Organization,2021.

[15]Chandrasekhar V,Krishnamurti C.George Papanicolaou(1883-1962):discoverer of the pap smear[J].J Obstet Gynaecol India,2018,68(3):232-235.

[16]Bouvard V,Wentzensen N,Mackie A,et al.The IARCperspective on cervical cancer screening[J].N Engl JMed,2021,385(20):1908-1918.

[17]魏丽惠,赵昀,沈丹华,等.中国子宫颈癌筛查及异常管理相关问题专家共识(一)[J].中国妇产科临床杂志,2017,18(2):190-192.

[18]Ying H,Jing F,Fanghui Z,et al.High-risk HPV nucleic acid detection kit-the care HPV test-a new detection method for screening[J].Sci Rep,2014,4(1):4704.

[19]Dang L,Kong L,Zhao Y,et al.Evaluation of triage strategies for high-risk human papillomavirus-positive women in cervical cancer screening:a multicenter randomized controlled trial in different resource settings in China[J].Chin J Cancer Res,2022,34(5):496.

[20]Muwonge R,Wesley RS,Nene BM,et al.Evaluation of cytology and visual triage of human papillomaviruspositive women in cervical cancer prevention in India[J].Int J of Cancer,2014,134(12):2902-2909.

[21]Torres-Ibarra L,Lazcano-Ponce E,Franco EL,et al.Triage strategies in cervical cancer detection in Mexico:methods of the frida study[J].Salud Publica Mex,2016,58(2):197-210.

[22]Khan MJ,Werner CL,Darragh TM,et al.Asccp colposcopy standards:role of colposcopy,benefits,potential harms,and terminology for colposcopic practice[J].J Low Genit Tract Dis,2017,21(4):223-229.

[23]Mayeaux Jr EJ,Novetsky AP,Chelmow D,et al.Asccp colposcopy standards:colposcopy quality improvement recommendations for the United States[J].J Low Genit Tract Dis,2017,21(4):242.

[24]Xue P,Ng MTA,Qiao Y.The challenges of colposcopy for cervical cancer screening in lmics and solutions by artificial intelligence[J].BMC Medicine,2020,18(1):169.

[25]Zhang S,Sun K,Zheng R,et al.Cancer incidence and mortality in China,2015[J].JNCC,2021,1(1):2-11.

[26]Su B,Zhong P,Xuan Y,et al.Changing patterns in cancer mortality from 1987 to 2020 in China[J].Cancers (Basel),2023,15(2):476.

[27]赫捷,陈万青.2020中国肿瘤登记年报[M].北京:人民卫生出版社,2022:171.

[28]Wen C.China’s plans to curb cervical cancer[J].Lancet Oncol,2005,6(3):139-141.

[29]李凌,徐小玲,徐延香,等.2008年-2010年四省7个筛查点子宫颈癌早诊早治实施情况介绍[J].中国肿瘤临床,2012,29(21):1648-1651.

[30]原中华人民共和国卫生部.农村妇女“两癌”检查项目管理方案[EB/OL].(2009-06-24)[2023-08-26].https://www.gov.cn/zwgk/2009-06/30/content_1353784.htm.

[31]国家卫生健康委员会.健康中国行动-癌症防治实施方案(2019-2022年)[EB/OL].(2019-09-20)[2023-08-26].https://www.gov.cn/zhengce/zhengceku/2019-11/13/content_5451694.htm.

[32]中华人民共和国国务院.中国妇女发展纲要(2021-2030年)[EB/OL].(2021-09-27)[2023-08-26].https://www.gov.cn/xinwen/2021-09/27/content_5639545.htm.

[33]国家卫生健康委员会.关于印发加速消除宫颈癌行动计划(2023-2030年)的通知[EB/OL].(2023-01-21)[2023-08-26].https://www.gov.cn/zhengce/2023-01/21/content_5738365.htm.

[34]刘书君,乔友林,周彩虹.多源流理论视角下HPV疫苗纳入免疫规划政策分析[J].中国公共卫生,2023,39(3):273-278.

[35]国家卫生健康委员会.新划入基本公共卫生服务工作规范(2019年版)[EB/OL].(2019-08-30)[2023-08-26].https://www.gov.cn/fuwu/2019-09/06/content_5427746.htm.

[36]国家卫生健康委员会.国家卫生健康委办公厅关于印发宫颈癌筛查工作方案和乳腺癌筛查工作方案的通知[EB/OL].(2021-12-31)[2023-08-26].http://www.nhc.gov.cn/fys/s3581/202201/cad44d88acca4ae49e12da b9176ae21c.shtml.

[37]广东省预防医学会宫颈癌防治专业委员会.消除子宫颈癌之HPV疫苗应用广东专家共识[J].中国医师杂志,2021,23(9):13.

[38]Zhang M,Zhong Y,Wang L,et al.Cervical cancer screening coverage-China,2018-2019[J].China CDC Weekly,2022,4(48):1077-1082.

[39]刘捷宸,吴琳琳,白庆瑞,等.上海市2017-2019年人乳头瘤病毒疫苗接种率和疑似预防接种异常反应监测[J].中国疫苗和免疫,2020,26(3):5.

[40]宋祎凡,刘晓雪,尹遵栋,等.2018-2020年中国9~45岁女性人乳头瘤病毒疫苗估算接种率[J].中国疫苗和免疫,2021,27(5):570-575.

[41]Hu SY,Zhao XL,Zhao FH,et al.Implementation of visual inspection with acetic acid and lugol’s iodine for cervical cancer screening in rural China[J].Int J of Gynecol Obstet,2023,160(2):571-578.

[42]Catarino R,Sch?fer S,Vassilakos P,et al.Accuracy of combinations of visual inspection using acetic acid or lugol iodine to detect cervical precancer:a meta‐analysis[J].BJOG,2018,125(5):545-553.

[43]张文华,刘剑锋,张华,等.基于互联网+的妇幼云平台设计与应用[J].医疗卫生装备,2019,40(6):36-39.

[44]Kramer J.Eradicating cervical cancer:lessons learned from Rwanda and Australia[J].Int J of Gynecol&Obstet,2021,154(2):270-276.

[45]Binagwaho A,Ngabo F,Wagner CM,et al.Integration of comprehensive women’s health programmes into health systems:cervical cancer prevention,care and control in Rwanda[J].Bull World Health Organ,2013,91(9):697-703.

[46]Brisson M,Kim JJ,Canfell K,et al.Impact of HPV vaccination and cervical screening on cervical cancer elimination:a comparative modelling analysis in 78 lowincome and lower-middle-income countries[J].The Lancet,2020,395(10224):575-590.

[47]Malone C,Barnabas RV,Buist DS,et al.Costeffectiveness studies of HPV self-sampling:a systematic review[J].Prev Med,2020,132(1):105953.

[48]Dreyer G,Botha MH,Snyman LC,et al.Combining cervical cancer screening for mothers with schoolgirl vaccination during human papillomavirus (HPV) vaccine implementation in South Africa:results from the vaccs 1and vaccs 2 trials[J].Int J Gynecol Cancer,2022,32(5):592-598.

[49]You T,Zhao X,Hu S,et al.Optimal allocation strategies for HPV vaccination introduction and expansion in China accommodated to different supply and dose schedule scenarios:a modelling study[J].E Clin Med,2023,56:101789.

[50]Whitworth HS,Gallagher KE,Howard N,et al.Efficacy and immunogenicity of a single dose of human papillomavirus vaccine compared to no vaccination or standard three and two-dose vaccination regimens:a systematic review of evidence from clinical trials[J].Vaccine,2020,38(6):1302-1314.

[51]Zhang J,Zhao Y,Dai Y,et al.Effectiveness of high-risk human papillomavirus testing for cervical cancer screening in China:a multicenter,open-label,randomized clinical trial[J].JAMA Oncol,2021,7(2):263-270.

[52]Zhu X,Li X,Ong K,et al.Hybrid AI-assistive diagnostic model permits rapid TBS classification of cervical liquid-based thin-layer cell smears[J].Nat Commun,2021,12(1):3541.

[53]Alsulami FT,Sanchez J,Rabionet SE,et al.Predictor of HPV vaccination uptake among foreign-born college students in the US:an exploration of the role of acculturation and the health belief model[J].Vaccines,2023,11(2):422.

[54]Reiter PL,Brewer NT,Gottlieb SL,et al.Parents’health beliefs and HPV vaccination of their adolescent daughters[J].Soc Sci Med,2009,69(3):475-480.

[55]World Health Organization.Comprehensive Cervical Cancer Control:A Guide to Essential Practice[M].2nd ed.Geneva:World Health Organization,2014.

[56]Lew JB,Simms KT,Smith MA,et al.Primary HPVtesting versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated:effectiveness and economic assessment for the national cervical screening program[J].Lancet Public Health,2017,2(2):e96-e107.

[57]Bai A,Wang J,Li Q,et al.Assessing colposcopic accuracy for high-grade squamous intraepithelial lesion detection:a retrospective,cohort study[J].BMC Women’s Health,2022,22(1):1-8.

[58]陈号,夏昌发,由婷婷,等.中国女性宫颈癌负担快速上升的原因及其应对措施[J].中华流行病学杂志,2022,43(5):761-765.

基本信息:

DOI:10.19757/j.cnki.issn1674-7763.2023.05.001

中图分类号:R737.33

引用信息:

[1]王慧珂,朱奕潼,丁晗玥,等.在低卫生资源环境下消除宫颈癌:从全球视角到中国视角[J].中国妇幼卫生杂志,2023,14(05):1-7.DOI:10.19757/j.cnki.issn1674-7763.2023.05.001.

基金信息:

腾讯公益慈善基金会(TF-20221116-00001-0001); 中国医学科学院医学与健康科技创新工程(2021-I2M-1-004)

检 索 高级检索