Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.
Department of Reproductive Health Research, World Health Organization, Geneva, Switzerland.
Vaccine. 2013 Dec 29;31 Suppl 5:F53-9. doi: 10.1016/j.vaccine.2012.06.070.
Cervical cancer is the leading cause of cancer morbidity and mortality in women in sub-Saharan Africa (SSA), accounting for about 50,000 deaths annually. Until recently, cytology was the gold standard for screening and prevention of cervical cancer. This method of screening has not been successful in SSA due to a lack of human, financial and material resources and poor health care infrastructure. It is estimated that less than 5% of at risk women have ever being screened. In the past two decades alternative approaches to cytology for cervical cancer screening have been evaluated in low- and medium-income countries. Visual inspection with acetic acid (VIA) and/or Lugol's iodine (VILI) have been shown to have adequate sensitivity, although low specificity, in a number of cross-sectional research and demonstration projects. Visual inspection methods require minimal resources, are technologically accessible, and are feasible for screening for precancerous lesions. Linking screening with VIA/VILI to treatment with cryotherapy may enable screening and treatment to take place in one visit, but this is likely to result in large numbers of women being subjected to unnecessary treatment. A number of studies have shown that cryotherapy is not associated with significant side effects or complications and is well tolerated. Creating the infrastructure for screening of older women is considered desirable, despite the limitations of visual inspection methods as screening tests. Understanding the role of human papillomavirus (HPV) infection in the etiology of cervical cancer and the discovery of HPV rapid test kits, as well as the development of vaccines against the HPV oncogenic types, have created new opportunities for prevention of cervical cancer. Trials and projects have established (and are still ongoing) the feasibility of using these molecular tests for screening. The ultimate in prevention method is primary prevention, offered by the advent of prophylactic vaccines against the most important oncogenic types, namely HPV16 and 18. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Sub-Saharan Africa Region" Vaccine Volume 31, Supplement 5, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
在撒哈拉以南非洲（SSA），宫颈癌是导致女性癌症发病率和死亡率的首要原因，每年约有 5 万人因此死亡。直到最近，细胞学检查一直是宫颈癌筛查和预防的金标准。然而，由于缺乏人力、财力和物力资源以及不完善的医疗保健基础设施，这种筛查方法在 SSA 并未取得成功。据估计，只有不到 5%的高危女性接受过筛查。在过去的二十年中，替代细胞学的方法已在中低收入国家进行了评估。在一些横断面研究和示范项目中，醋酸视觉检查（VIA）和/或卢戈氏碘液视觉检查（VILI）已被证明具有足够的敏感性，尽管特异性较低。视觉检查方法所需资源最少，技术上易于操作，并且适用于筛查癌前病变。将筛查与 VIA/VILI 相结合，再辅以冷冻疗法治疗，可以在一次就诊中完成筛查和治疗，但这可能导致大量女性接受不必要的治疗。许多研究表明，冷冻疗法不会引起明显的副作用或并发症，且耐受性良好。尽管视觉检查方法作为筛查试验存在局限性，但为老年女性建立筛查基础设施仍被认为是可取的。了解人乳头瘤病毒（HPV）感染在宫颈癌病因学中的作用以及 HPV 快速检测试剂盒的发现，以及针对 HPV 致癌型的疫苗的开发，为宫颈癌的预防创造了新的机会。试验和项目已经证实（并且仍在进行中），这些分子检测可用于筛查。预防的终极方法是一级预防，即针对最重要的致癌型 HPV16 和 18 推出预防性疫苗。本文是题为“撒哈拉以南非洲地区 HPV 感染及相关疾病的综合控制”的区域报告的一部分，发表于 2013 年疫苗第 31 卷增刊 5 期。该领域的最新进展在题为“HPV 感染及相关疾病的综合控制”的单独专论中介绍，发表于 2012 年疫苗第 30 卷增刊 5 期。
