子宮頸抹片篩檢間隔是否會影響篩檢成效?Will Pap smear screening interval influence the efficacy of screening for cervical cancer?

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2019-07-19 已刊登
新刊登 綜 整 綜合類型

作  者

孫嘉璟* 蕭君婷* 鄭鈺郿 劉翠瑤

實證知識類別

A 類:實證健康照護綜整

PICO

綜合型

治療/介入措施

婦產科與婦女健康 Obstetrics, Gynecology and Women's Health

科別

  • 婦女健康 Women’s Health

中文關鍵詞

子宮頸癌 子宮頸抹片篩檢 篩檢間隔

英文關鍵詞

cervical cancer cervical cancer screening screening interval

機構名稱

臺北市立聯合醫院

申請單位

和平婦幼院區護理科

中文摘要

形成臨床提問:
我國補助30歲以上女性每年一次子宮頸抹片檢查,2006至2016年確診子宮頸癌比率從每十萬人口7.4人降至5.5人[1],有定期篩檢對預防子宮頸癌的成果較佳[3]。雖抹片篩檢存在20%偽陰性,學者認為以多次抹片來矯正此誤差[2],但成本效益分析的研究指出不再建議每年進行抹片檢查,因為每3年一次篩檢的成本效益較佳,頻繁篩檢增加過度治療及後續醫療成本[5]。經子宮頸篩檢為陰性,其45個月內子宮頸癌前病變3級或原位癌呈低相關,因此,建議可延長篩檢間隔[8;11]。
文獻搜尋的方法與分析:
依據實證護理步驟,形成一個可回答的臨床問題,以「PICO」關鍵字搜尋,cervical cancer、cervical cancer screening、screening interval等,並使用MESH檢索同義字於PubMed、MEDLINE、Cochrane Library及華藝圖書館,限制十年內英文文獻,符合檢索限制及PICO的文章共3篇,其中2篇為非隨機病例對照之系統性文獻回顧及1篇大型的世代研究。使用英國國民保健署(National Health Service, NHS)所發展的評讀工具Critical Appraisal Skills Programme (CASP),適用系統性文獻回顧及世代研究設計。
文獻的品質評讀:
運用文獻評讀工具CASP文獻評讀工具,嚴格評讀文獻之可信度、結果重要性及推廣應用性(Validity, Importance/ Impact, Practice),依照Oxford CEBM 2011 Levels of Evidence分類證據等級,2篇非隨機病例對照型系統性文獻回顧為Level 2,1篇大型世代研究為Level 2。CASP評讀證據品質,Meggiolaro(2016)評讀答案為不明確多達5題,2題為否定,不建議採信本篇結果;另外兩篇研究結果相似且多題評讀為”是”,採信其結果作為實務參考 [4;7]。
結論與建議:
實證文獻結果每2年或3年一次子宮頸篩檢提供良好的保護,並提升婦女接受篩檢的意願,有助於早期發現癌前病變,早期治療之策略,且預防子宮頸癌的篩檢效果間隔最長可延至5年一次。目前研究建議30歲以上健康女性間隔每2或3年進行一次子宮頸抹片篩檢。

英文摘要

Ask an answerable question (PICO):
Pap smear screening once every year for women over the age of 30 is included in the National Health Insurance in Taiwan. From 2006 to 2016, the prevalence of cervical cancer has decreased from 7.4 to 5.5 (person/0.1 million) [1]. Regular screening is believed to yield better result [3], but with 20% of false negative result. Therefore, scholars suggest errors could be corrected by multiple screenings [2]. However, the result of cost-effectiveness analysis suggested performing smear screening once every three years instead of every year. Frequent screening may increase the possibility of over-treatment and medical costs [5]. There is a low correlation between a negative Pap smear and a stage III cervical cancer or carcinoma in situ within 45 months. It is recommended to extend the screening interval [8;11] .
The Method and Analysis of Literature Review:
Based on the empirical nursing procedures, answerable clinical questions were proposed, using "PICO" to conduct keyword search: Cervical Screening, Interval, Cervical Cancer etc. The study applied MeSH to search for synonyms in PubMed, MEDLINE, Cochrane Library and Airiti Library online database. All the articles were limited to publications written in English in the recent decade. Three articles met the search queries and PICO, and among them two articles were systematic literature reviews and one cohort study. The review tool used in the study was the (CASP) developed by National Health Service of the U.K., suitable for systematic literature reviews and cohort studies.
Critical Appraisal:
The study employed CASP to closely evaluate the validity, importance, impact, and practice of the articles collected. According to Oxford CEBM 2011 Levels of Evidence, two systematic literature reviews were graded as level 2 and the cohort study level 2. Among ten questions evaluated with CASP, paper written by Meggiolaror (2016) had five items rated as “uncertain” and two “negative,” indicating the result invalid. Most of the items of the other two papers were rated as “yes,” indicating that the results could be used as references [4; 7].
Conclusions and Recommendations:
The result proved Pap smear screening performed once every two or three years could provide better protection and raise the willingness of screening. It also helped patients detect earlier stage cervical cancer and start early treatment. The screening interval could be extended to once every five year. Therefore, the study recommended Pap smear screening once every two or three years for women over the age of 30.