Cervical cancer remains one of the main causes of female mortality, especially in middle- and low-income countries, despite efforts towards the implementation of global vaccination against human papillomavirus (HPV). The aim of this study was to review and compare the most recently published international guidelines providing recommendations on cervical cancer screening strategies among average and high-risk women. Thus, a comparative review of guidelines by the US Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the American Society of Clinical Oncology (ASCO), the World Health Organization (WHO), the Canadian Task Force on Preventive Health Care (CTFPHC), the Cancer Council Australia (CCA), and the European Guidelines (EG) was conducted. There is an overall agreement regarding the suggestions made for women younger than 21 and those older than 65, with all guidelines stating against routine screening, with the exceptions of CTFPHC and CCA that expand the age group to up to 70 and 75 years, respectively. Continuation of screening in older women is also suggested in those with a history of a precancerous lesion and those with inadequate screening. Most guidelines recommend routine screening at 30–65 years, while the WHO advises that screening should be prioritized at 30–49 years. HPV DNA testing is the method of choice recommended by most guidelines, followed by cytology as an alternative, except for CTFPHC, which refers to cytology only, with self-sampling being an acceptable method by most medical societies. Agreements exist regarding recommendations for specific groups, such as women with a history of total hysterectomy for benign reasons, women with a complete vaccination against HPV, individuals from the lesbian, gay, bisexual, transgender, and queer communities and women with multiple sexual partners or early initiation of sexual activity. On the other hand, the age group of 21–29 is addressed differently by the reviewed guidelines, while differentiations also occur in the screening strategies in cases of abnormal screening results, in women with immunodeficiency, those with in utero exposure to diethylstilbestrole and pregnant women. The development of consistent practice protocols for the most appropriate cervical cancer screening programs seems to be of major importance to reduce mortality rates and safely guide everyday clinical practice.
宫颈癌仍是导致女性死亡的主要原因之一，在中低收入国家尤为突出，尽管全球范围内已推行人乳头瘤病毒疫苗接种计划。本研究旨在系统回顾并比较最新发布的国际指南中关于普通风险与高风险女性宫颈癌筛查策略的建议。通过对美国预防服务工作组、美国癌症协会、美国临床肿瘤学会、世界卫生组织、加拿大预防保健工作组、澳大利亚癌症委员会及欧洲指南的对比分析发现，各指南对21岁以下及65岁以上女性的筛查建议基本一致，均不推荐常规筛查，但加拿大工作组和澳大利亚委员会分别将年龄上限扩展至70岁和75岁。对于有癌前病变史或既往筛查不充分的老年女性，多数指南建议继续筛查。大多数指南推荐30-65岁女性进行常规筛查，而世界卫生组织建议优先覆盖30-49岁人群。除加拿大工作组仅推荐细胞学检查外，多数指南将HPV DNA检测列为首选方法，细胞学检查作为备选方案，且自我采样已获多数医学会认可。各指南在特定人群筛查建议上存在共识，包括因良性疾病行全子宫切除术者、完成HPV疫苗接种者、性少数群体以及多性伴或性行为过早者。然而，21-29岁年龄段的筛查方案存在差异，对于筛查结果异常、免疫缺陷、宫内己烯雌酚暴露及妊娠期女性的筛查策略亦有所不同。建立统一的宫颈癌筛查临床实践方案对降低死亡率及安全指导临床诊疗具有重要意义。
Screening for Cervical Cancer: A Comprehensive Review of Guidelines
肿瘤(癌症)患者之家