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[JAMA ÃֽŠº¸°í : 2019³â ÀڱðæºÎ¾Ï °ËÁø½Ã±â¿Í ¹æ¹ý]

Cervical Cancer Screening: More Choices in 2019

JAMA Insights Women's Health

May 28, 2019

 

 

 

 

[¹è°æ] 

 

´ë»óÀÚ±â¹Ý°ËÁø(Population-based screening)ÀÇ Àû¿ëÀº Áö³­ ¼ö½Ê ³â µ¿¾È ¹Ì±¹¿¡¼­ ÀڱðæºÎ¾Ï ¹ßº´·ü°ú »ç¸Á·üÀÇ ÇöÀúÇÑ °¨¼Ò¿¡ ±â¿©Çß´Ù. ±×·¯³ª ÀÌ·¯ÇÑ ¹ßÀü¿¡µµ ºÒ±¸ÇÏ°í, 2018³â¿¡´Â ¾à 13,240¸íÀÇ ¹Ì±¹ ¿©¼ºµéÀÌ ÀڱðæºÎ¾Ï Áø´ÜÀ» ¹Þ¾Ò°í, 470 ¸íÀÇ ¿©¼ºµéÀÌ ÀÌ Áúº´À¸·Î »ç¸ÁÇß´Ù.

 

ÀÏ°üµÇ°í ¸¹Àº ¾çÀÇ Áõ°ÅµéÀÌ ÀÎÀ¯µÎÁ¾¹ÙÀÌ·¯½º(hrHPV)ÀÇ °íÀ§ÇèÇü °¨¿°(high-risk types)À» ÀڱðæºÎ¾ÏÀÇ ¿øÀÎÀÌ µÇ´Â ÀÎÀÚ·Î º¸°íÇÏ°í ÀÖ´Ù. ÀÌ·¯ÇÑ °¨¿°µéÀº ³ª°í ¼ºÇàÀ§¸¦ ÇÏ´Â ´ëºÎºÐÀÇ ¿©¼º¿¡°Ô ÈçÇÏ°Ô ³ªÅ¸³­´Ù.

 

´ëºÎºÐÀÇ °¨¿°Àº ¸î ³â µ¿¾È ÀÓ»óÀû ÀÇÀǾøÀÌ ÇØ°áµÇÁö¸¸, ¿µ±¸ °¨¿°Àº Àڱà °æºÎ¾ÏÀ¸·Î ÁøÇàµÉ ¼ö ÀÖ´Â ÀڱðæºÎ »óÇdz» ½Å»ý¹°(cervical intraepithelial neoplasia, CIN 2 µî±Þ ¹× 3 µî±Þ)°ú °°Àº °íÀ§Ç輺 ÀڱðæºÎ¾ÏÀ¸·Î À̾îÁú ¼ö ÀÖ´Ù. ´ë·« CIN Grade 3 º´º¯ÀÇ 30 %´Â 30³â¿¡ °ÉÃÄ Ä§½À¼º ¾ÏÀ¸·Î ÁøÇàµÈ´Ù . ÀÌ·¯ÇÑ ´À¸° ÁøÇàÀº ÀÌ·¯ÇÑ ¾Ïº´º¯À» Á¶±â¿¡ ¹ß°ßÇÏ°í Ä¡·áÇÒ ¼ö ÀÖ´Â ¸¹Àº ±âȸ¸¦ Á¦°øÇÔÀ¸·Î½á °á°úÀûÀ¸·Î ¾ÏÀ¸·ÎÀÇ ÁøÇàÀ» ¹æÁöÇÑ´Ù.

 

 

 

Table 1. 21¼¼¿¡¼­ 65¼¼ ¿©¼ºÀÇ ÀڱðæºÎ¾Ï °ËÁø °¡À̵å¶óÀÎ: US Preventive Services Task Force (USPSTF, 2018) Current Cervical Cancer Screening Guidelines for Women Aged 21 to 65 Years: US Preventive Services Task Force (USPSTF, 2018)1, American College of Obstetricians and Gynecologists (ACOG, 2016)2, American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathologists (2012)3

Abbreviations: hrHPV, high-risk human papillomavirus; HIV, human immunodeficiency virus; CIN2+, cervical intraepithelial neoplasia grade 2, grade 3, adenocarcinoma in situor cervical cancer

aWomen with no prior diagnosis of CIN2+, women who are not immunocompromised and women with noin utero exposure to diethylstilbestrol

bPer USPSTF; considered an alternative strategy for women aged 25 and older by ACOG

cPer ACOG,based on recommendations by the Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents4; ACOG guidelines state that it is reasonable to extrapolate the recommendations for women with HIV infection to those who are immunocompromised due to non-HIV causes such as solid organ transplantation.

dPer ACOG

 

 

¿ø¹® URL:https://jamanetwork.com/journals/jama/article-abstract/2734304

 

 

2019³â JAMA ´ë»óÀÚ±â¹Ý°ËÁø(Population-based screening) °¡À̵å¶óÀΠ

 

1.    ÀÏ¹Ý ¿©¼º °ËÁø ½ÃÀÛ ½Ã±â : 21¼¼ ¿©¼ººÎÅÍ ½ÃÀÛ

 

2.    ³ªÀÌ¿¡ µû¸¥ °ËÁø ¹æ¹ý°ú °£°Ý

       

-21-65¼¼ : ¸Å 3³â¸¶´Ù ¼¼Æ÷°Ë»ç(cytology every 3y)

 

ȤÀº

 

-21-29¼¼ :¸Å 3³â¸¶´Ù ¼¼Æ÷°Ë»ç(cytology every 3y)

30-65¼¼: ¸Å 5³â¸¶´Ù ¼¼Æ÷°Ë»ç¿Í ÀÎÀ¯µÎÁ¾¹ÙÀÌ·¯½º °Ë»ç(cytology plus hrHPV testing every 5y)

 

ȤÀº

 

-21-29¼¼ : ¸Å 3³â¸¶´Ù ¼¼Æ÷°Ë»ç(cytology every 3y)

-30-65¼¼ : ¸Å 5³â¸¶´Ù ÀÎÀ¯µÎÁ¾¹ÙÀÌ·¯½º °Ë»ç

                  (hrHPV testing every 5y)

 

 

3. HIV °¨¿° ¿©¼ºµé

(Women immunocompromised by HIV infection)

 

°ËÁø ½ÃÀÛ ½Ã±â

¼ºÇàÀ§°¡ ½ÃÀÛµÈ Áö 1 ³â À̳»¿¡, ¶Ç´Â ÀÌ¹Ì ¼º°ü°è¸¦ °¡Á³´Ù¸é HIV Áø´Ü ÈÄ 1 ³â À̳»¿¡, 21 ¼¼º¸´Ù ´ÊÁö ¾Êµµ·Ï ÇÔ.

 

-21-65¼¼ : ¸Å³â ¼¼Æ÷°Ë»ç ÈÄ 3³âµ¿¾È Á¤»óÀ¸·Î ³ªÅ¸³ª¸é, ÀÌÈÄ ¸Å 3³â¸¶´Ù °ËÁø(cytology every year; after 3 consecutive annual normal cytology test results, screening can be every 3y)

 

ȤÀº

- 21-29¼¼ : À§ÀÇ ¼¼Æ÷°Ë»ç(cytology as above)

 

-30-65¼¼ : ¸Å 3³â¸¶´Ù ¼¼Æ÷°Ë»ç¿Í ÀÎÀ¯µÎÁ¾¹ÙÀÌ·¯½º °Ë»ç(cytology plus hrHPV testing every 3y)

 

 

  

 

 

 

References

1.     U. S. Preventive Services Task Force. Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(7):674-686.

2.     Practice Bulletin No. 168 Summary: Cervical Cancer Screening and Prevention. Obstet Gynecol. 2016;128(4):923-925.

3.     Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-172.

4.     Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdfAccessed on March 20, 2019.

 

 

 

 


2019-07-03 ¿ÀÈÄ 4:04:26, Á¶È¸¼ö : 2578