HPV vaccination and cervical cancer screening.pdf

Screening can cause harm (eg, anxiety, further tests, diagnostic labels, costs, morbidity, and death). Sometimes, a screening programme can bring net benefits when the Wilson and Jungner criteria are applied. Screening can detect problems too early, leading to overdiagnosis and overtreatment, resulting in high financial costs, morbidity, and death. Screening healthy people should be considered a medical failure, a second-rate and burdensome approach, and at best should be a temporary, contingent stopgap between the real successes of prevention and cure. Screening (of healthy people) and early diagnosis (with speedy management of symptomatic patients) are ethically and scientifically distinct, but often wrongly elided. The UK National Health Service, policy makers, and the general public need to understand that programmes should be continuously interrogated and dismantled as they become redundant to release funds for something more effective and to liberate people from the constant anxiety of routine check-ups and self-checking. The preliminary observational data about the effects of England’s national human papillomavirus (HPV) vaccination programme from Milena Falcaro and colleagues’ study show that the programme has almost eliminated cervical cancer and precancer, albeit data only being available for women up to age 25 years. The positive implications of changing the natural history of this disease were not anticipated or addressed. It is inevitable that the death and morbidity trade-offs will change from benefits towards harms, especially given the known lifelong risks of prematurity in the offspring of women with surgically damaged cervices. The criteria for the screening programme should be reviewed to determine if and when it should be offered to only those who have not had an HPV vaccination. Cervical cancer screening at the population level should not continue when previous harm to benefit weighings and justification have vanished.

筛查可能会造成伤害（例如，焦虑、进一步检查、诊断标签、成本、发病率和死亡）。有时，当应用威尔逊和杨格纳标准时，筛查计划可以带来净收益。筛查可以过早发现问题，导致过度诊断和过度治疗，从而导致高昂的财务成本、发病率和死亡。筛查健康人应被视为医疗失败、二流和繁重的方法，充其量应该是预防和治疗真正成功之间的临时、偶然的权宜之计。筛查（健康人）和早期诊断（迅速处理有症状的患者）在伦理和科学上是不同的，但经常被错误地忽略。英国国家卫生服务局、政策制定者和公众需要了解，应该不断审问和取消计划，因为它们变得多余，以便为更有效的事情释放资金，并将人们从例行检查和自我检查的持续焦虑中解放出来-检查。米莱娜法尔卡罗及其同事研究的关于英格兰国家人乳头瘤病毒 (HPV) 疫苗接种计划效果的初步观察数据表明，该计划几乎消除了宫颈癌和癌前病变，尽管数据仅适用于 25 岁以下的女性。没有预料到或解决改变这种疾病的自然史的积极影响。死亡和发病率的权衡不可避免地会从益处转向危害，尤其是考虑到宫颈手术损伤妇女的后代存在早产的已知风险。应审查筛查计划的标准，以确定是否以及何时应仅向未接种 HPV 疫苗的人提供筛查计划。当以前的利益权衡和理由已经消失时，不应继续在人群层面进行宫颈癌筛查。