PO.PR01.02 · 预防研究
宫颈癌筛查中的全球不平等：一项证据综合
The global inequality in cervical cancer screening: An evidence synthesis
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摘要 Abstract
中文摘要
背景：宫颈癌全球负担的上升以及筛查可及性方面持续存在的不平等，凸显了加强实施的必要性。因此，我们汇编了不同国家/地区的宫颈癌筛查指南，并评估了其实施状况和覆盖情况。
方法：在本研究中，我们对PubMed、Embase和Web of Science数据库（自建库至2025年2月1日）、相关网站以及世界卫生组织（WHO）数据库进行了全面检索。纳入分析的研究提供了各国官方宫颈癌筛查建议的详细信息。所有指标均根据人类发展指数（HDI）、收入水平、地理位置、WHO区域、疾病风险和年龄等因素进行分层。该系统综述已在Prospero前瞻性注册（注册号：CRD420251087263）。
结果：我们的研究纳入了来自77个国家/地区的数据，其中仅62.3%（48/77）提供了方案发布/更新的年份。在77个国家中，62个（80.5%）以细胞学作为主要筛查检测。醋酸肉眼观察（VIA）是低HDI国家最常推荐的检测。使用人乳头瘤病毒（HPV）检测的国家数量相对较少。筛查覆盖率与HDI/收入相关（低HDI：12.43%对极高HDI：49.74%；高收入：51.68%对低收入和中等收入国家[LMICs]：34.45%），高风险区域（29.88%）显著低于其他地区（46.76%）。年龄分层分析显示，20-29岁和70-79岁组覆盖率最低，而30-39岁组覆盖率最高。我们的结果还显示筛查质量指标（阳性率、进一步评估率、检出率和阳性预测值[PPV]）存在显著异质性。
结论：本研究凸显了宫颈癌筛查指南方面的全球不平等，尤其体现在不同国家/地区筛查方法的转变上。全球宫颈癌覆盖率仍显著低于70%的目标。应加快筛查策略，改善筛查-诊断-治疗的可及性，建立监测系统，并加强全球合作。关键词：宫颈癌；全球健康；卫生政策；筛查；覆盖率；系统综述
查看英文原文 English abstract
Background: The rising global burden of cervical cancer and persistent inequalities in screening access underscore the need to strengthen implementation. Therefore, we compiled the cervical cancer screening guidelines from different countries/regions and evaluated their implementation status and coverage situation.
Methods: In this study, we conducted comprehensive search of the PubMed, Embase and Web of Science databases (from their establishment to February 1, 2025), websites and the World Health Organization (WHO) database. Studies included in our analysis provide detailed information on the official cervical cancer screening recommendations for each country. All indicators were stratified based on factors such as human development index (HDI), income level, geographical location, WHO regions, disease risk, and age. The systematic review was prospectively registered at Prospero (registration number: CRD420251087263).
Results: Our study incorporated data from 77 countries/regions, only 62.3% (48/77) of them provided the year of published/updated protocol. Cytology was the primary screening test in 62 (80.5%) of 77 countries. Visual inspection with acetic acid (VIA) was the most recommended test in low HDI countries. The number of countries using Human papillomavirus (HPV) is relatively small. Screening coverage was associated with HDI/income (low HDI: 12.43% vs very high HDI: 49.74%; high-income: 51.68% vs low income and middle-income countries [LMICs]:34.45%), with high-risk regions (29.88%) significantly lower than other areas (46.76%). Age-stratified analysis showed minimal coverage in the 20-29 and 70-79 groups, while coverage peaked in the 30-39 group. Our results also showed substantial heterogeneity in screening quality indicators (positive rate, further assessment rate, detection rate, and positive predictive value [PPV]).
Conclusions: This study highlights global inequities in cervical cancer screening guidelines, particularly in the transition of screening methods among different countries/regions. Global cervical cancer coverage remains significantly below the target of 70%. Accelerate screening strategies, improve screening-diagnosis-treatment accessibility, establish monitoring systems, and strengthen global cooperation. Key words: Cervical cancer; Global health; Health policy;Screening, Coverage, Systematic review
利益披露 Disclosure
R. Xin, None..
X. Wu, None..
B. Zhu, None.