Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia.
Drugs. 2010 Jun 18;70(9):1079-98. doi: 10.2165/10898580-000000000-00000.
Worldwide, cervical cancer is the second most common cancer of women. Less-developed countries bear the greatest burden in terms of morbidity and mortality, largely due to the lack of organized screening programmes. Cervical cancer is the first cancer shown to be caused solely by virological agents: oncogenic genotypes of human papillomavirus (HPV). Two recently developed prophylactic cervical cancer vaccines, which are based on viral-like particle (VLP) technology of HPV, have the capacity to diminish a large proportion of cervical cancer cases worldwide. However, to be successful public health tools, they need to be widely implemented to the appropriate target population, preferably prior to first sexual intercourse. To increase vaccination coverage, national programmes in some countries have also included catch-up vaccination, for a limited time period, to young adult women aged up to 26 years. Despite the excellent efficacy for high-grade dysplasia due to vaccine-related HPV types (near to 100%) and immunogenicity induced against the HPV types 16 and 18 in females naive to those HPV types pre-vaccination, some form of cervical precancer screening will still be necessary. Immunity to HPV is primarily type specific, and thus protection induced by the current generation of vaccines, based on a limited number of HPV VLP types, cannot provide complete protection against all oncogenic HPV types. Both these vaccines translate to protection of cervical cancer in the order of 70-75%, which represents the percentage of invasive cancers attributable to HPV-16 and -18. Challenges to ensuring the successful control of this largely preventable disease include endorsement by governments and policy makers, affordable prices, education at all levels, overcoming barriers to vaccination and continued adherence to screening programmes.
在全球范围内，宫颈癌是女性中第二常见的癌症。欠发达国家在发病率和死亡率方面负担最重，主要原因是缺乏有组织的筛查计划。宫颈癌是第一个被证明仅由病毒制剂引起的癌症：人乳头瘤病毒（HPV）的致癌基因型。最近开发的两种预防性宫颈癌疫苗基于 HPV 的病毒样颗粒（VLP）技术，有能力减少全球很大一部分宫颈癌病例。然而，要成为成功的公共卫生工具，它们需要广泛应用于适当的目标人群，最好是在首次性行为之前。为了提高疫苗接种率，一些国家的国家计划还包括在有限的时间内为年龄在 26 岁以下的年轻成年女性进行补种疫苗。尽管针对疫苗相关 HPV 类型（接近 100%）的高级别发育不良和针对 HPV 16 和 18 型的免疫原性诱导的疫苗接种具有极好的效果，但仍需要进行某种形式的宫颈癌前筛查。HPV 感染的免疫主要是特定类型的，因此，目前基于有限数量 HPV VLP 类型的疫苗所诱导的免疫并不能为所有致癌 HPV 类型提供完全保护。这两种疫苗都能在一定程度上预防宫颈癌，其保护率在 70-75%之间，这代表了 HPV-16 和 -18 型引起的浸润性癌症的比例。确保成功控制这种在很大程度上可预防的疾病的挑战包括政府和政策制定者的认可、价格合理、各级教育、克服疫苗接种障碍以及持续遵守筛查计划。
