决心和宫颈肿瘤的高管

文摘

直到1980年代的最后一部分宫颈筛查是信徒驱动,因而很不一致。它只是在最近的十年有一个合理的计划,vith打电话审查和全科医生的目标。已经不言自明:筛选的影响程度populaion已经从大约45 - 35%以上,有了一个情感的变化ncidence和死亡率。尽管宫颈筛查项目的易感性和pecificity杰瑞高,针对数字显然包括虚假的结果导致问题。扩大敏感性与随后的扩张不可避免地提示直言不讳的下降在不安和潜在意义治疗。

关键字

不利影响;药物;药理学。

关于的研究

常常忘了他筛查规划的对象,不是diagrose和治疗宫颈上皮内瘤,但宫颈. o预防癌症。我们无法区别——:ntiate之间那些积极和tt筛选高患宫颈癌的风险从那些vho筛选阳性但风险很少najor困难和非常昂贵。因此,imporante不重新划线的其他形式的调查项目,例如,HPV亚型est。然而,无论新系统可能introluced,我们必须记住,这是在东一样好我们现有的计划。该计划是,在某种程度上,其)wn成功的受害者。随着覆盖范围的人口增加绝大多数与侵袭性癌症的患者:ervix过去将会被屏蔽,repre, ent筛选过程的失败。许多这些vi11过去正常的涂片和可能。代表疾病的快速发展但有些将代表错误的影响。正是这些导致诉讼和负面宣传。讽刺的是,许多这些案件浮出水面,因为同意的应用和评估标准的实验室在英国。 When standards are set, unless they are to be set at such a low level as to be almost meaningless, there will always be outliers who will need to address their problems in order to meet the standards. Despite having the best large population-based cervical screening programme in the world, the way in which the outliers in our system have been identified and their identification publicised has had the unfortunate effect of decreasing national confidence in the screening programme itself The publicity has driven cytoscreeners and cytopathologists into a more cautious approach, unbalancing the relationship between specificity and sensitivity with a consequent increase in overinvestigation, overtreatment, cost and morbidity. Whilst it is tempting to lay the blame for this at the door of a sensationalist media or the litigation lawyers, it is, arguably, more the effect of the misplaced zeal of colleagues acting as expert witnesses, demanding unrealistic and, probably, unachievable outcomes. The pathology service, and particularly the cervical screening programme, has been a standard bearer to the rest of the profession in the introduction of assessment, revalidation and clinical governance. It is to be hoped that the experience of the cytopathologists will be put to good use in avoiding a further series of public relations disasters.