摘要目的 探讨机会性筛查在65岁及以上老年女性宫颈癌筛查中的作用.方法 回顾性分析2010年1月至2018年12月在中国医学科学院肿瘤医院防癌科进行宫颈癌筛查的1 304名65岁及以上女性的筛查资料,均进行宫颈液基细胞学(TCT)和人乳头瘤病毒(HPV)联合筛查.按年龄将其分为65～69岁和≥70岁2组,并对TCT和HPV筛查结果阳性的女性进行随访,分析机会性筛查中65岁及以上老年女性的TCT异常情况及高危型HPV感染率.结果 1 304名宫颈癌筛查者中,65～69岁年龄组640人,≥70岁年龄组664人;TCT异常或高危型HPV阳性者共175例,TCT阳性69例(5.3%),其中高度鳞状上皮内病变17例(24.6%),鳞状细胞癌3例(4.4%).65～69岁年龄组总的TCT异常率为6.7%(43例),高于≥70岁年龄组3.9%(26例),差异有统计学意义(P=0.024).高危型HPV感染139例(10.7%),其中阳性率最高的亚型是58型,有31例(17.9%),其次常见的感染亚型依次为16、52、33、31型.随访发现,有50.3%的女性10年内从未进行过筛查,5年内至少进行过1次筛查(80例)和5年内从未进行过筛查的女性(87例)的TCT异常率和高危型HPV感染阳性率差异均无统计学意义(P均>0.05).结论 重视65岁及以上老年女性的宫颈癌筛查,机会性筛查可以与人群组织性筛查有效衔接,适当延长老年女性的筛查终止年龄.

abstractsObjective To investigate the role and significance of opportunistic screening in cervical cancer screening for elderly women aged≥65 years old. Methods The screening data of 1 304 elderly women (≥65 years old) who underwent opportunistic screening for cervical cancer at the Cancer Hospital, Chinese Academy of Medical Sciences, between January 1, 2010, and December 31 st, 2018, were analyzed retrospectively. Women who underwent cervical cytology tests and human papillomavirus (HPV) testing were divided into two groups according to age as following 65-69 and ≥70 years old. Women with abnormal cytology or who were hrHPV-positive were followed up. The cervical cytological abnormalities and high-risk HPV infection rates in women aged≥65 years in opportunistic screening were analyzed. Results Of all cases, 175 had abnormal cytology or were hrHPV-positive. Among the 1 304 women, 69 were TCT-positive, with a positivity rate of 5.3%, including 17 cases (24.6%) of high-degree squamous intraepithelial neoplasia and 3 cases (4.4%) of squamous cell carcinoma. The total abnormality rate of TCT in the 65-to 69-year age group (6.7%, 43 cases) was significantly higher than that in the≥70 age group (3.9%, 26 cases), and the difference was statistically significant between the two groups (P=0.024). The overall prevalence of hrHPV infection was 10.7% (139/1 304). HPV58 (31/174, 17.9%) was identified as the most common high-risk HPV type, followed by HPV16, HPV52, HPV33, and HPV31. Follow-up showed that 50.3% of the women had never been screened in the past 10 years, and no statistically significant difference in TCT abnormality and hrHPV infection positivity rate were found between those who had been screened (80 cases) and those who had not been screened at least once in 5 years (87 cases) (P>0.05). Conclusion Attention should be paid to the screening for cervical cancer in elderly women aged ≥65 years old. Opportunistic screening is a supplement to the population-based organized cervical cancer screening. The termination age of cervical cancer screening for elderly women may be appropriately extended.