两癌筛查系统的检查项目与特点

　　两癌筛查系统（针对宫颈癌与乳腺癌）是通过系统化检查实现早期发现、早期诊断的健康保障体系，其检查项目兼顾精准性与普适性，特点鲜明，在女性健康管理中发挥着关键作用。

　　The two cancer screening system (for cervical cancer and breast cancer) is a health security system that realizes early detection and early diagnosis through systematic examination. Its examination items give consideration to accuracy and universality, with distinctive characteristics, and play a key role in women's health management.

　　宫颈癌筛查项目注重阶梯式排查。首先进行宫颈细胞学检查（巴氏涂片或液基薄层细胞学检测），采集宫颈脱落细胞，通过显微镜观察细胞形态，判断是否存在异常增生或癌变倾向，液基检测的细胞保存更完整，异常细胞检出率比传统巴氏涂片提高 20% 以上。若细胞学检查发现异常，需进一步做 HPV（人乳头瘤病毒）检测，因为 90% 以上的宫颈癌与高危型 HPV 持续感染相关，检测可明确病毒亚型（如 HPV16、18 型为高危中的高危），为后续干预提供依据。对于 HPV 阳性或细胞学结果可疑者，需通过阴道镜检查放大宫颈组织，在可疑区域取活检，经病理诊断确认是否癌变，形成 “细胞学 / HPV 检测 — 阴道镜 — 病理” 的三级筛查链条，逐步提升诊断精准度。

　　The cervical cancer screening program focuses on a step-by-step screening approach. Firstly, cervical cytology examination (Pap smear or liquid based thin-layer cytology) is performed to collect cervical exfoliated cells. The morphology of the cells is observed under a microscope to determine whether there is an abnormal proliferation or cancer tendency. Liquid based examination preserves the cells more completely, and the detection rate of abnormal cells is increased by more than 20% compared to traditional Pap smear. If abnormalities are found in cytological examination, further HPV (human papillomavirus) testing is required, as over 90% of cervical cancers are associated with persistent infection with high-risk HPV types. Testing can identify virus subtypes (such as HPV16 and 18, which are considered high-risk) and provide a basis for subsequent interventions. For individuals who are HPV positive or have suspicious cytological results, it is necessary to enlarge cervical tissue through colposcopy examination, take biopsy from the suspicious area, and confirm whether there is cancer through pathological diagnosis, forming a three-level screening chain of "cytology/HPV testing - colposcopy - pathology", gradually improving diagnostic accuracy.

　　乳腺癌筛查项目结合影像与临床检查。基础项目为乳腺触诊，医生通过手法检查乳房有无肿块、乳头溢液、皮肤凹陷等异常体征，操作简便且无创伤，适合大规模初筛。影像检查中，乳腺超声是常用手段，能清晰显示乳腺组织层次，区分囊性与实性肿块，对致密型乳腺（年轻女性常见）的检查敏感性优于钼靶。40 岁以上女性或高危人群（如家族乳腺癌史）需加做乳腺钼靶检查，通过低剂量 X 线成像，可发现超声难以识别的微小钙化（乳腺癌早期常见表现），两种影像手段结合能将早期检出率提升至 85% 以上。对于疑似病例，需进行乳腺磁共振（MRI）检查，其软组织分辨率更高，可评估病变范围及血供情况，为活检或手术方案提供参考。

　　Breast cancer screening program combines imaging and clinical examination. The basic project is breast palpation, where doctors use manual examination to check for abnormal signs such as lumps, nipple discharge, and skin depressions in the breast. The operation is simple and non-invasive, suitable for large-scale initial screening. In imaging examination, breast ultrasound is a commonly used method that can clearly display the hierarchy of breast tissue, distinguish cystic and solid masses, and has better sensitivity than mammography for dense breast (common in young women). Women over 40 years old or high-risk groups (such as family history of breast cancer) need additional mammography. Through low-dose X-ray imaging, small calcifications that are difficult to identify by ultrasound (common early manifestations of breast cancer) can be found. The combination of two imaging methods can increase the early detection rate to more than 85%. For suspected cases, breast magnetic resonance imaging (MRI) examination is required, which has higher soft tissue resolution and can evaluate the extent of lesions and blood supply, providing reference for biopsy or surgical plans.

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