2024 Hong Kong College of Obstetricians and Gynaecologists Guidelines for cervical cancer prevention and screening

Abstract

<p>Primary prevention of cervical cancer is best achieved by vaccinating girls with a prophylactic human papillomavirus (HPV) vaccine. Despite the high efficacy of such vaccines, cervical cancer screening remains necessary because current vaccines do not offer full protection. Secondary prevention via cervical screening should target all women from age 25 years or at the onset of sexual activity, whichever occurs later, until age 64 years. Screening is recommended at 3-year intervals after two consecutive normal annual cytology results, or at 5-year intervals using HPV-based testing (either HPV co-test with cytology or HPV stand-alone). Women who have undergone hysterectomy with cervix removal for benign disease and have no prior history of cervical dysplasia can discontinue screening. Women with HPV-positive, cytology-negative co-test results should either undergo repeat co-testing in 12 months or immediate HPV16/18 genotyping. Immediate referral of women with positive stand-alone HPV test results for colposcopy without further triage is not recommended. A second triage test using cytology, genotyping for HPV16/18, or p16/Ki-67 dual-stain should be conducted to accurately identify women at high risk for high-grade lesions who thus require colposcopy referral. Women with HPV-positive, cytology-positive co-test results, or high-grade abnormal cytology results should be referred for colposcopy. Treatment with a loop electrosurgical excision procedure is recommended for women with high-grade squamous intraepithelial lesions (HSILs). After HSIL treatment, long-term follow-up with HPV-based testing over 25 years is preferred. When cytology results show atypical glandular cells, colposcopy and sampling of the endocervix and endometrium are recommended.<br></p>

為女童接種預防性人類乳頭瘤病毒（HPV）疫苗可以最好地實現子宮頸癌的初級預防。儘管此類疫苗功效很高，但由於目前的疫苗無法提供全面保護，子宮頸癌篩查仍屬必要。子宮頸癌的二級預防通過子宮頸篩查實現，應針對所有25歲或性生活開始後（以較晚者為準）的女性，直到64歲。我們建議在連續兩個年度細胞學結果均為正常後每3年進行一次篩查，或每5年通過基於HPV檢測（HPV與細胞學聯合檢測或HPV獨立檢測）進行篩查。因良性疾病接受子宮切除術並已切除子宮頸且沒有子宮頸上皮內瘤病變史的婦女可以停止篩查。HPV與細胞學聯合檢測結果為HPV陽性而細胞學陰性的婦女應在12個月後重複聯合測試或立即進行HPV16/18基因分型測試。對於HPV獨立檢測結果為陽性的婦女，未進行任何進一步分流測試前，不建議直接轉介陰道鏡檢查，而應使用細胞學、HPV16/18基因分型測試或p16/Ki-67雙染進行分流測試，以準確識別患有高級別病變的高風險女性，從而轉介陰道鏡檢查。聯合測試結果為HPV陽性及細胞學性，或細胞學結果為高級別異常的婦女應被轉介陰道鏡檢查。對於高級別鱗狀上皮病變的婦女，建議進行電圈切除手術治療。治療後，推薦使用基於HPV的檢測進行25年以上的長期隨訪。當細胞學結果顯示非典型腺細胞時，建議進行陰道鏡檢查及子宮頸內膜和子宮內膜活檢。