宫颈癌及癌前病变筛查手段

近年来随着宫颈癌病因学研究的进展,以及科学技术的飞速发展,一些新技术不断应用到宫颈癌的筛查,现就宫颈癌筛查状况及进展作一综述.     

美国宫颈癌研究进展

目前分子流行病学研究表明ＨＰＶ感染是宫颈癌的主要危险因素，本文主要介绍了宫颈癌发生的流行病学，病因学，癌前病变的治疗，宫颈癌病人的临床分期和生存期，宫颈防癌涂片检查，药物预防干预研究的进展情况，同时提及今后尚需进一步研究的问题。     

宫颈癌防治研究进展

摘 要：随着宫颈癌病因学研究取得突破性进展,宫颈癌防治有了明显进步。已经明确HPV持续感染与宫颈癌密切相关。HPV预防性疫苗成功研制并在临床推广应用,使宫颈癌病因学预防成为可能,宫颈癌防治可以提前到一级预防。目前情况下,二级预防即宫颈癌与癌前病变的筛查及早期诊断与早期治疗仍然是宫颈癌防治的重要手段。宫颈癌筛查手段也在不断改进与进步之中,与宫颈癌防治策略有关的卫生经济学相关问题将日益受到重视。     

宫颈癌及癌前病变筛查手段

近年来随着宫颈癌病因学研究的进展，以及科学技术的飞速发展，一些新技术不断应用到宫颈癌的筛查，现就宫颈癌筛查状况及进展作一综述。     

HPV预防性疫苗在中国的应用前景

近年来宫颈癌的病因学研究取得了一系列突破性进展,20世纪80年代初德国病毒学家Harald Zur Hausen首次提出人乳头瘤病毒（HPV）感染与子宫颈癌密切相关的假设,随后证实HPV感染是宫颈癌发生的主要原因。1995年,IRAC专题讨论会上确定了HPV感染是子宫颈癌发生的必要条件;     

宫颈癌病因研究进展

宫颈癌是危害广大妇女健康的主要恶性肿瘤之一。然而对于它的病因一直处于研究探索阶段,从血清流行病学到实验诱癌动物模型等方面都作了很多工作。随着现代分子生物学技术高速发展,使得宫颈癌病因学在病毒学、免疫学和分子生物学等方面有了新的突破。下面综述宫颈癌研究近况。宫颈癌病因因素从大量流行病学调查结果发现宫颈癌可能与性行为(包括较早年第一次性交,多个配偶及多胎)以及性传播性疾病,如淋病〔4〕、衣原体HSV、HCMV、HPV感染有关。另外还与性激素、吸烟〔5〕及经济状况     

口腔HPV感染与口咽癌发生的相关性及临床意义

吸烟、饮酒是口咽癌已知的常见病因.近年来,宫颈癌病因学研究取得了突破性进展,证实了高危型的人乳头瘤病毒(HPV)感染是宫颈癌发生的必要条件.新近的研究表明,感染有转录活性的HPV的头颈癌,其基因表达谱完全不同于没有感染HPV的肿瘤,表明HPV感染在头颈鳞癌的形成过程中发挥了重要的作用.本文就口腔HPV感染与口咽癌发生的相关性及临床意义予以综述.     

宫颈癌的流行病学

世界每年宫颈癌的新病例数约为44万，位居妇女常见恶性肿瘤的第二位。M.H．Schiffman等最近在美国华盛顿召开的“全国妇科癌症会议”上，就宫颈癌的流行病病因学及危险因素作了较为全面的阐述。一、人乳头状病毒（HPV）的感染人乳头状病毒（HPV）感染是宫颈癌的主要危险因素。现已被鉴定的同源HPV多达70余种类型。且每型HPV都有其特有的易感宿主和疾病谱。与宫颈癌相关的HPV最常见的有16、18、31、45等10余种类型。据世界各地一系列的研究证明，绝大部分宫颈癌普遍含有10－15种相同类型的HPV。而几乎所有的研究结果都一致认为，HP…     

宫颈癌细胞中P21表达的研究

宫颈癌是妇科常见的恶性肿瘤之一，严重危害妇女的生命与健康,由于宫颈癌的病因至今尚不明确，故关于宫颈癌病因学方面的研究，特别是癌变分子机制的研究越来越受到重视。近年来，已在许多恶性肿瘤中发现ras癌基因产物P21的表达在肿瘤的发生，发展过程中起着重要作用。本研究应用ras癌基因产物P21单抗对宫颈炎，     

宫颈癌病毒病因研究的过去与未来

自60年代中期以来,国内外对宫颈癌病毒病因学进行了深入的研究。回顾过去的20年,大致可分为两个阶段:60年代中期至80年代初,重点研究了单纯疱疹二型病毒(HSV-2)与宫颈癌相互间的关系;70年代末期至今则偏重研究了人乳头瘤病毒(HPV)与     

Multifaceted Usage of HPV Related Tests and Products in the Management of Cervical Cancer - a Review

HPV viruses are integral to the development of cervical cancer. The pathogenesis has been extensivelystudied. To date, numerous HPV tests and products have been developed and successfully utilized in diagnosis,treatment and prevention of cervical cancer. The HPV DNA test, when combined with other routine cervicalcancer screening and diagnostic tests namely exfoliative cytology, visual inspection with acetic acid (VIA) andcolposcopy has increased the detection rate of cervical cancer. HPV DNA products could also be measured inother body fluids like urine, lymph node tissue, and serum. HPV association could also be quantified by measuringother parameters like HPV mRNA, viral load, viral integration and methylation status. Vaccination against HPVhas been found to decrease the incidence of cervical cancer. Further, therapeutic vaccines for cervical canceragainst HPV continue to evolve. All these findings pertaining to HPV could possibly decrease the incidence ofcervical cancer in the near future. This review aims to give an overview of the HPV tests and products in useand those under trial currently.     

HPV与宫颈癌

人乳头瘤病毒(HPV)的感染已被证实与宫颈癌的发生有密切关系.超过2/3的宫颈癌与HPV16或HPV18感染有关.HPV预防性疫苗研制的成功则是子宫颈癌预防研究的里程碑.     

Current status of cervical cancer and HPV infection in Korea

Cervical cancer is an important cause of cancer-related deaths in women in developing countries. In Korea, cervical cancer is the third leading cancer among females and is fifth highest in mortality. The persistent oncogenic human papillomavirus (HPV) infections are the greatest risk of developing cervical intraepithelial neoplasia and invasive cancer. The overall prevalence of HPV was 10.4% in Korea and strong risk factors for HPV infection included a young age at sexual debut. The National Cancer Screening Program, which includes cervical cancer screening, has the following principles: the main screening tool is the Papanicolaou test conducted by gynecologists, which targets all women age 30 and over, and which is done every 2 years. HPV DNA tests have not yet been permitted as a screening test for cervical cancer in Korea; however, these are conducted along with a Pap test for screening cervical cancer in the clinic. The use of prophylactic HPV vaccine has been accepted in Korea; The Korean Society of Gynecologic Oncology and Colposcopy''s recommendation for routine vaccination is for females aged 15-17 years with a catch-up vaccination recommended for females aged 18-26 years who have not been previously vaccinated. However, many people in Korea are not familiar with the HPV vaccine. Therefore, it is necessary to improve awareness for the disease and HPV vaccination and to establish the effective strategies to obtain funding for HPV vaccination. In the future, cervical cancer is expected to disappear throughout the world, including the Asia Pacific region, through a combination of vaccination and qualified screening programs for cervical cancer.     

New insights into cervical cancer screening

Worldwide, cervical cancer is a leading cause of cancer related morbidity and mortality. For over 50 years, cervical cytology has been the gold standard for cervical cancer screening. Because of its profound effect on cervical cancer mortality in nations that have adopted screening programs, the Pap smear is widely accepted as the model screening test. Since its introduction, many studies have analyzed the Pap smear and found that it is not without its shortcomings including low sensitivity for detection of cervical intraepithelial neoplasia 2/3. Additionally, the discovery of infection with the human papillomavirus (HPV) as a necessary step in the development of cervical cancer has led to the development of HPV testing as an adjunct to cytology screening. More recently, researchers have compared HPV testing and cytology in the primary screening of cervical cancer. In this review, we will discuss cytologic testing limitations, the role of HPV DNA testing as an alternative screening tool, the impact of the HPV vaccine on screening, and future directions in cervical cancer screening.     

Indications and Efficacy of the Human Papillomavirus Vaccine

Opinion statement In the United States, there are 11,150 cases and 3670 deaths projected due to invasive cervical cancer for 2007. Approximately 500,000 new cases and 274,000 deaths will occur in women throughout the world. Human papillomavirus (HPV) has been designated by the World Health Organization (WHO) as a “necessary cause” of cervical cancer. There are 6.2 million new cases of HPV diagnosed each year. In addition to cervical cancer, the virus has also been implicated in vaginal, vulvar, penile, anal, and head and neck cancers. Current methods for prevention of cervical cancer include Pap smears, HPV testing, ablative procedures, cervical conization, and hysterectomy. These are costly as well as invasive. The HPV vaccine is the most recent breakthrough for the prevention of cervical cancer. The quadrivalent HPV vaccine (Gardasil™) covers types 6, 11, 16, & 18. The bivalent vaccine (Cervarix™) covers types 16 & 18, and is expected to come out in the early part of 2007. Approximately 70% of cervical cancer is caused by HPV types 16 & 18. HPV types 6 &11 are responsible for 90% of anogenital warts. Females of ages 11–12 and those prior to their sexual debut should be vaccinated, with all females in the age range of 9–26 also eligible. This vaccination strategy can prevent the above HPV infections, cervical dysplasia, and possibly cervical cancer.     

HPV and cervical neoplasia: review of case-control and cohort studies.

Epidemiological studies on the association between human papillomavirus (HPV) and cervical cancer are reviewed. Studies using HPV DNA hybridization methods to assess the presence of viral markers have yielded compelling evidence that HPV has a causal role in the disease: the association is strong, consistent and specific to a limited number of viral types. A dose-response relationship has been reported between increasing estimated viral load and risk of cervical cancer. Indirect evidence suggests that HPV DNA detected in cancer cells is a good marker of HPV infection occurring before cancer development. An increased risk for progression to more advanced CIN lesions has been reported among HPV 16/18-positive women as compared to women with other HPV types or to women without any viral DNA.     

Demonstration of smoking-related DNA damage in cervical epithelium and correlation with human papillomavirus type 16, using exfoliated cervical cells.

Smoking is a known aetiological risk factor for cervical cancer. Smoking-related DNA damage (DNA adducts), in cervical epithelial cells, has recently been demonstrated to suggest a causal role in the development of cervical cancer. Human papillomavirus 16 (HPV 16) is a known oncogenic virus and is also implicated as a cause of cervical cancer. It has been suggested that both smoking and HPV may act synergistically in the development of cervical cancer. We have investigated the cervical DNA adduct level and the prevalence of HPV 16 (using polymerase chain reaction) in women who had normal cervical cytology. Both the DNA adduct assay and the HPV assay were carried out on exfoliated cervical cells recovered from cervical scrapes. In 87% of the cases there was enough DNA from the exfoliative cervical cells to analyse for DNA adducts. Smokers had higher DNA adduct levels than non-smokers (P = 0.002), confirming the previous data from cervical biopsy samples. Forty-two per cent of the specimens were found to be HPV 16 positive. There was no significant difference in smoking-related DNA damage (DNA adduct levels) between HPV-positive and HPV-negative smokers. This suggests that smoking DNA damage does not augment HPV infectivity. These results do not, therefore, support the molecular synergism theory.     

预防性 HPV 疫苗的临床应用进展及思考

宫颈癌是女性生殖系统最常见的恶性肿瘤,并且高危型人乳头瘤病毒（human papillomavirus, HPV）持续感染与宫颈癌的密切关系已经得到流行病学及临床研究证实。因此,HPV 疫苗在预防 HPV 持续感染及宫颈相关病变等方面备受瞩目。本文对目前美国 FDA 批准上市的3种预防性疫苗的临床应用进展进行综述,同时列举出一些尚存在争议的问题,旨在引起人们的重视及共同思考。     

Papillomaviruses and cancer: from basic studies to clinical application

Links between human papillomaviruses (HPVs) and cervical cancer were first suspected almost 30 years ago. DNA of specific HPV types has since been found in almost all cervical cancer biopsies. HPV oncogenes that are expressed in these cells are involved in their transformation and immortalization, and are required for the progression towards malignancy. Epidemiological studies have underlined that HPVs are the main aetiological factor for cervical cancer. But how has this knowledge been translated into the clinic to allow the prevention, screening and treatment of cervical cancer?     

人乳头瘤病毒疫苗防治宫颈癌研究的新进展

宫颈癌的发病率在女性恶性肿瘤居第二位,人乳头状瘤病毒(HPV)感染已被证实为宫颈癌发生的主要因素,采用HPV疫苗防治HPV感染和宫颈癌是最根本的病因治疗方法,其中HPV疫苗分为预防性疫苗和治疗性疫苗两大类,本文综述了近几年关于HPV疫苗的研究成果.