Insist on going to the hospital for HPV screening every year, the doctor suggested that it is "not necessary"

This article involves professional knowledge and is only for reference by medical professionals.
Excessive screening can also bring a burden to health.

In recent years, more and more women have gone to the gynecology department for cervical cancer screening, but over-screening may put a burden on women’s health.

Many women are also very distressed: Do they need to be screened? How often should the screening be performed? What items are included in the screening? At the recent 2021 American College of Obstetricians and Gynecologists (ACOG) annual meeting, Dr.
Rebecca Perkins from the United States gave the answer: What is HPV and cytology? After clarifying the inspection frequency, many people will pay attention to the screening items.

At present, the patients who are followed up mainly need to do HPV testing and cytology testing.

Cytological examination is mainly to obtain exfoliated cells after collecting vaginal or cervical secretions.
After staining, observe the cell morphology, which can be used to judge cervical cancer, human papillomavirus and other infections.

HPV testing is mainly through DNA methods to directly detect whether there is HPV virus.

Compared with cytology, clinicians currently prefer HPV testing because the sensitivity of cytology to detect CIN3 lesions is much lower than that of HPV screening (50%-70% vs 90%).

Therefore, in the process of follow-up, doctors often give priority to HPV testing.
Only when HPV testing cannot be achieved for some reasons, cytology testing alone is used to monitor precancerous lesions.

Figure 1: Only cytological examination has no long-term protective effect on CIN grade 3 lesions.
This means that over time, many missed patients will develop cervical cancer.
The latest ACOG guidelines indicate that when HPV results are positive, combined cells should be considered Learn to check.

If cytology is not available, but HPV type 16 or 18 is positive, then colposcopy is required immediately.

If cytology is performed and HPV 16/18 infection is found, colposcopy should be performed immediately and a biopsy should be taken.

How often should the screening be done? Who needs to do it? Cervical cancer screening mainly screens cervical epithelial dysplasia (CIN).

This is a kind of precancerous lesions, most of which are caused by HPV, especially high-risk HPV infections like types 16 and 18.

According to the severity of the lesion, it is divided into three grades: CIN1, CIN2, and CIN3.
The higher the grade, the closer to the development of cervical cancer.

Figure 2: Most HPV infections will disappear within 1-3 years, and persistent infections may cause CIN grade 3 lesions.

(Red: progression to cancer or precancerous lesions; yellow: persistent infection; green: undetectable virus) In most patients infected with HPV, the virus is basically undetectable in about 1-3 years, although this does not mean that the virus is completely Disappear, but as long as the cervix has no obvious manifestations of viral infection, the probability of transforming into precancerous lesions or cancer is reduced.

For these patients, excessive screening can cause a lot of damage.

Therefore, scientific screening is very important[1]: For women aged 25-29, screening every 3 years is recommended; for women aged 30-64, cytology combined with HPV testing is recommended every 3-5 years .

So, which groups do not need to be screened for cervical cancer? Generally speaking, women under the age of 25 do not need to be screened.
If they are women 65 years and older, they must meet the following conditions [1]: No HIV infection; no history of cervical cancer; no record of precancerous lesions in the past 25 years; At least 3 Pap smears or 2 HPV tests are negative, there is no need for cervical cancer screening.

Changes in HPV Management Model Dr.
Rebecca Perkins shared that the current management of HPV is undergoing a revolution.
Doctors have changed from simply looking at screening results to comprehensively assessing patients based on risk.

This is because more and more evidence shows that if you only rely on test results to screen for HPV, it is easy to miss some high-risk patients.

Figure 3: Patients with different medical histories are at risk of developing CIN3 or cancer.
In addition to examination results, medical history is also very important for HPV management.
If patients have a history of treatment with CIN2 and above, the risk of cervical cancer will be significantly increased.
At that time, it should be combined with medical history and examination results to make a comprehensive judgment.

This is like the difference between a paper map and GPS navigation.
A guide based only on the test results is more like a map.
When you have a problem, just flip through the map.

The risk-based guide is more like a GPS.
According to different road conditions, even the same starting place and destination, you may be prompted to take different routes based on different real-time and past data.

To put it simply, the risk-based decision-making process is mainly that doctors classify patients into high-risk, high-risk, intermediate-risk, and low-risk risk levels based on the patient's HPV test results and past medical history, and then deal with them in order of priority.

As shown in the table below: For extremely high-risk patients, most of them have high-grade precancerous lesions found by colposcopy, and they need immediate surgery.

For low-risk patients, doctors may recommend reducing their screening times to avoid excessive examinations.

So, what are the advantages of risk-based HPV management? It can quickly assess patients and divide them into different priority levels for corresponding treatment; it can quickly diagnose and treat high-risk patients to prevent them from developing cancer.

For low-risk patients, traumatic examinations are greatly reduced, avoiding excessive medical treatment.

I believe that after such a change, doctors can distinguish priorities more quickly and provide patients with more accurate and targeted diagnosis and treatment.

References: [1]Screening for cervical cancer us preventive services task force recommendation statement.
JAMA:the Journal of the American Medical Association.
*Sponsored by the Science Popularization Project of Shanghai Science and Technology Commission (Project Number: 20DZ2311000)