Schneider Achim, Schwarz Tino F, Hammerschmidt Thomas, Siebert Uwe
Klinik für Gynäkologie und gynäkologische Onkologie, Charité, Berlin.
Med Klin (Munich). 2007 Jul 15;102(7):515-23. doi: 10.1007/s00063-007-1065-9.
Human papillomavirus (HPV) is a necessary cause for cervical cancer. HPV vaccines covering genotypes 16 and 18 for the prevention of cervical cancer are or will be available soon (status: May 2007). Vaccination against HPV in order to reduce the burden of cervical cancer is recommended by the Standing Committee on Vaccination (STIKO) for female adolescents aged 12-17 years in Germany. The study aims to evaluate the achievable long-term impact of HPV vaccination on invasive cervical cancer (ICC) incidence and mortality in Germany, a country with an opportunistic Pap screening program and suboptimal participation.
The authors developed a decision-analytic discrete-event model and used Monte Carlo simulation to assess the impact of vaccination on ICC incidence and life expectancy of a cohort of 399,400 10-year-old girls. HPV-16 and HPV-18 account for 73.5% of cancers. In the model, a 100% vaccination rate between 10 and 25 years, and a vaccine efficacy of 95.1% were assumed.
Without vaccination, 4,563 ICC cases occur in the cohort (cumulative lifetime incidence: 1.14%), 1,376 women will die from ICC (fatality: 30.2%). Vaccination at age 10 can reduce incidence and mortality by 70% resulting in a gain of 17,819 life-years. 416 girls have to be vaccinated to prevent one death from ICC. Delaying vaccination to women aged 25 years still leads to a 50% reduction of deaths.
Despite cytological screening, a high disease burden of cervical cancer remains in Germany. Vaccination in early adolescence can drastically reduce the disease burden. Vaccination of adult women still offers significant benefits. Therefore, HPV vaccination should be added to existing cancer prevention strategies.
人乳头瘤病毒（HPV）是宫颈癌的必要病因。预防宫颈癌的涵盖16和18型基因型的HPV疫苗已上市或即将上市（状态：2007年5月）。德国疫苗接种常务委员会（STIKO）建议，对12 - 17岁的女性青少年接种HPV疫苗，以减轻宫颈癌负担。本研究旨在评估在德国这一实施机会性巴氏涂片筛查计划且参与率欠佳的国家，HPV疫苗接种对浸润性宫颈癌（ICC）发病率和死亡率可实现的长期影响。
作者建立了一个决策分析离散事件模型，并使用蒙特卡洛模拟来评估疫苗接种对一组399,400名10岁女孩的ICC发病率和预期寿命的影响。HPV - 16和HPV - 18导致73.5%的癌症。在模型中，假设10至25岁之间的疫苗接种率为100%，疫苗效力为95.1%。
不接种疫苗时，该队列中会发生4,563例ICC病例（累积终生发病率：1.14%），1,376名女性将死于ICC（死亡率：30.2%）。10岁时接种疫苗可使发病率和死亡率降低70%，从而增加17,819个生命年。必须为416名女孩接种疫苗才能预防一例ICC死亡。将疫苗接种推迟到25岁的女性仍可使死亡人数减少50%。
尽管进行了细胞学筛查，德国宫颈癌的疾病负担仍然很高。青春期早期接种疫苗可大幅减轻疾病负担。成年女性接种疫苗仍有显著益处。因此，应将HPV疫苗接种纳入现有的癌症预防策略。
