Background We propose an economical cervical screening research and implementation strategy designed to take into account the typically slow natural history of cervical cancer and the severe but hopefully temporary impact of COVID-19. The commentary introduces the practical validation of some critical components of the strategy, described in three manuscripts detailing recent project results in Asia and Africa. The main phases of a cervical screening program are 1) primary screening of women in the general population, 2) triage testing of the small minority of women that screen positive to determine need for treatment, and 3) treatment of triage-positive women thought to be at highest risk of precancer or even cancer. In each phase, attention must now be paid to safety in relation to SARS-CoV-2 transmission. The new imperatives of the COVID-19 pandemic support self-sampled HPV testing as the primary cervical screening method. Most women can be reassured for several years by a negative test performed on a self-sample collected at home, without need of clinic visit and speculum examination. The advent of relatively inexpensive, rapid and accurate HPV DNA testing makes it possible to return screening results from self-sampling very soon after specimen collection, minimizing loss to follow-up. Partial HPV typing provides important risk stratification useful for triage of HPV-positive women. A second “triage” test is often useful to guide management. In lower-resource settings, visual inspection with acetic acid (VIA) is still proposed but it is inaccurate and poorly reproducible, misclassifying the risk stratification gained by primary HPV testing. A deep-learning based approach to recognizing cervical precancer, adaptable to a smartphone camera, is being validated to improve VIA performance. The advent and approval of thermal ablation permits quick, affordable and safe, immediate treatment at the triage clinic of the majority of HPV-positive, triage-positive women. Conclusions Overall, only a small percentage of women in cervical screening programs need to attend the hospital clinic for a surgical procedure, particularly when screening is targeted to the optimal age range for detection of precancer rather than older ages with decreased visual screening performance and higher risks of hard-to-treat outcomes including invasive cancer.

中文翻译：

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设计考虑到 COVID-19 的低成本、准确的宫颈筛查策略：自我采样 HPV 分型的作用2

背景 我们提出了一种经济的宫颈筛查研究和实施策略，旨在考虑宫颈癌通常缓慢的自然病程以及 COVID-19 的严重但希望是暂时的影响。评论介绍了该战略一些关键组成部分的实际验证，三份手稿详细描述了亚洲和非洲最近的项目成果。宫颈筛查计划的主要阶段是 1) 对普通人群中的女性进行初步筛查，2) 对筛查呈阳性的少数女性进行分诊测试以确定是否需要治疗，以及 3) 对被认为是患癌前病变甚至癌症的风险最高。在每个阶段，现在都必须注意与 SARS-CoV-2 传播相关的安全性。COVID-19 大流行的新要求支持将自我取样 HPV 检测作为主要的宫颈筛查方法。大多数女性可以通过在家中收集的自我样本进行的阴性测试而放心数年，而无需进行门诊就诊和窥器检查。相对便宜、快速和准确的 HPV DNA 检测的出现使得可以在样本采集后很快返回自我采样的筛查结果，从而最大限度地减少随访损失。部分 HPV 分型为 HPV 阳性女性的分流提供了重要的风险分层。第二次“分类”测试通常有助于指导管理。在资源较少的地区，仍建议使用醋酸 (VIA) 进行目视检查，但它不准确且可重复性差，错误分类了初级 HPV 检测获得的风险分层。一种基于深度学习的识别宫颈癌前病变的方法，适用于智能手机相机，正在被验证以提高 VIA 的性能。热消融的出现和批准允许在大多数 HPV 阳性、分诊阳性妇女的分诊诊所进行快速、负担得起和安全的立即治疗。结论 总体而言，宫颈筛查项目中只有一小部分女性需要到医院诊所进行外科手术，特别是当筛查的目标是检测癌前病变的最佳年龄范围，而不是视觉筛查性能下降和风险较高的年龄较大时难以治疗的结果，包括浸润性癌症。热消融的出现和批准允许在大多数 HPV 阳性、分诊阳性妇女的分诊诊所进行快速、负担得起和安全的立即治疗。结论 总体而言，宫颈筛查项目中只有一小部分女性需要到医院诊所进行外科手术，特别是当筛查的目标是检测癌前病变的最佳年龄范围，而不是视觉筛查性能下降和风险较高的年龄较大时难以治疗的结果，包括浸润性癌症。热消融的出现和批准允许在大多数 HPV 阳性、分诊阳性妇女的分诊诊所进行快速、负担得起和安全的立即治疗。结论 总体而言，宫颈筛查项目中只有一小部分女性需要到医院诊所进行外科手术，特别是当筛查的目标是检测癌前病变的最佳年龄范围，而不是视觉筛查性能下降和风险较高的年龄较大时难以治疗的结果，包括浸润性癌症。