Cancer Epidemiology Research Program, Catalan Institute of Oncology (Institut Català d'Oncologia - ICO) & Bellvitge Biomedical Research Institute (IDIBELL), Avda. Gran Via 199 - 203, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
Expert Opin Pharmacother. 2011 Oct;12(14):2189-204. doi: 10.1517/14656566.2011.596527. Epub 2011 Jul 15.
Academic research has made a significant advancement in understanding the viral causes of cervical cancer and generating the technology for prevention, both at the primary and secondary levels. Human papillomaviruses (HPVs) have been recognized as the first necessary cause of cervical cancer, the second most common cancer in women worldwide.
This paper reviews the epidemiological evidence of the causality of HPV in relation to cervical cancer, other genital tract cancers and some cancers of the oral cavity and oropharynx. The review also covers HPV DNA testing as a screening tool. DNA probes of high-risk HPV types in different formats have been fully validated as primary screening tests, as secondary triage tests and as a prognostic marker following treatment of high grade squamous intraepithelial lesions (HSIL). They consistently showed significant superiority over the conventional Pap smears. Biomarkers of the activation of oncogenes (HPV mRNA, p16 and other) are being tested as screening options to improve in sensitivity and specificity, with promising results. HPV vaccines against the two most common HPV types in cancer have completed their Phase III trials with excellent results in efficacy and safety. Combined strategies of HPV vaccination and HPV-based screening tests could theoretically control cervical cancer in any population in which a large coverage with both preventive options is ensured. Accessibility of developing countries to vaccination and low-cost HPV screening options are the barriers to overcome at present.
This paper provides a synthesis of the evidence available supporting the novel paradigm for cervical cancer prevention that has reached a large consensus within the mainstream HPV and cervical cancer prevention research communities. The available technology for prevention and its developments allows real opportunities for cervical cancer elimination in defined populations to be foreseen.
学术研究在理解宫颈癌的病毒病因和开发初级及二级预防技术方面取得了重大进展。人乳头瘤病毒（HPV）已被确认为宫颈癌的首要致病因素，也是全球女性第二大常见癌症。
本文综述了 HPV 与宫颈癌、其他生殖道癌症以及部分口腔和口咽癌症之间因果关系的流行病学证据。本文还涵盖了 HPV DNA 检测作为筛查工具的应用。不同形式的高危型 HPV DNA 探针已充分验证可作为初级筛查试验、二级分流试验以及高级别鳞状上皮内病变（HSIL）治疗后的预后标志物。它们与传统巴氏涂片相比，具有显著的优势。致癌基因激活的生物标志物（HPV mRNA、p16 等）正在作为提高敏感性和特异性的筛查选择进行测试，结果令人鼓舞。针对癌症中两种最常见 HPV 类型的 HPV 疫苗已完成 III 期临床试验，在疗效和安全性方面取得了优异的结果。HPV 疫苗接种与 HPV 为基础的筛查试验相结合的策略，从理论上可以控制任何人群中的宫颈癌，只要确保两种预防措施的广泛覆盖。发展中国家在疫苗接种和低成本 HPV 筛查选择方面的可及性是目前需要克服的障碍。
本文提供了对支持宫颈癌预防新范式的现有证据进行综合，该范式在主流 HPV 和宫颈癌预防研究界已达成广泛共识。现有的预防技术及其发展为在特定人群中消除宫颈癌提供了切实的机会。
