Dillner J
Deptartment of Epidemiology, School of Public Health, Tampere University, Tampere, Finland.
J Clin Virol. 2000 Oct;19(1-2):7-23. doi: 10.1016/s1386-6532(00)00126-8.
The establishment of human papillomavirus (HPV) infection as a major cause of cervical neoplasia has resulted in major efforts to develop prophylactic HPV vaccines for prevention of cervical neoplasia. Cervical cancer and the other HPV-associated cancers constitute a major public health burden and eradication of the major causative infection is certainly the most appealing long-term preventive measure. Nevertheless, the effects of preventive HPV vaccination will need to be estimated and compared for (cost-) efficacy with other primary prevention and with secondary prevention programs. However, estimating the effects of preventing a causative exposure is complicated when the exposure is a transmissible infection. The spread of the epidemic is dynamic and may change over time depending e.g. on the changes in human behavior. Depending on the circumstances, prevention of an infection may have either greater or lesser effects than the prevention of a non-infectious exposure. Estimating the time trends in HPV infections and the underlying trends in the risk of cervical neoplasia is important for estimating effects of interventions.
A literature review on recent evidence on time trends in cervical neoplasia, compared with evidences on time trends in HPV infections and interactions between different types of HPV infections.
In Finland, there has between 1991 and 1995 been a 60% increase in the incidence of cervical cancer among women <55 years of age. Trends in detection rates of cervical cancer precursor lesions are consistent with an increase in the background cervical cancer risk. From the 1960s to 1980s, there has been a major increase in HPV seroprevalences over time in the Nordic countries. Increasing trends are also seen for other sexually transmitted diseases and smoking. Several studies indicate the existence of interaction between benign and oncogenic HPV types, thus making the relationship between the incidences in HPV infections and in cervical neoplasia complex.
The increase in cervical cancer is paralleled by increases in HPV infection, other STDs and smoking and changes in screening practices, all of which may have contributed. Prediction of the effect on cervical cancer incidence of changes in HPV incidences is complicated by the existence of several risk factors, the protective effect of screening and by the population dynamics of HPV infections.
人乳头瘤病毒（HPV）感染被确认为宫颈癌的主要病因后，人们付出了巨大努力来研发预防性HPV疫苗以预防宫颈癌。宫颈癌和其他与HPV相关的癌症构成了重大的公共卫生负担，根除主要致病感染无疑是最具吸引力的长期预防措施。然而，需要评估预防性HPV疫苗接种的效果，并与其他一级预防和二级预防项目进行（成本-）效益比较。然而，当暴露因素是一种可传播的感染时，估计预防这种致病暴露的效果会很复杂。该流行病的传播是动态的，可能会随时间变化，例如取决于人类行为的改变。根据具体情况，预防感染的效果可能比预防非传染性暴露的效果更大或更小。估计HPV感染的时间趋势以及宫颈癌发生风险的潜在趋势对于评估干预措施的效果很重要。
对近期有关宫颈癌时间趋势的证据进行文献综述，并与HPV感染的时间趋势以及不同类型HPV感染之间相互作用的证据进行比较。
在芬兰，1991年至1995年间，55岁以下女性宫颈癌发病率上升了60%。宫颈癌前病变的检出率趋势与宫颈癌背景风险的增加一致。从20世纪60年代到80年代，北欧国家HPV血清阳性率随时间大幅上升。其他性传播疾病和吸烟也呈上升趋势。多项研究表明良性和致癌性HPV类型之间存在相互作用，因此HPV感染发病率与宫颈癌发病率之间的关系很复杂。
宫颈癌发病率的上升与HPV感染、其他性传播疾病和吸烟的增加以及筛查实践的变化同时出现，所有这些因素都可能起到了作用。由于存在多种风险因素、筛查的保护作用以及HPV感染的人群动态变化，预测HPV发病率变化对宫颈癌发病率的影响很复杂。
