Cancer Epidemiology Research Program (CERP), Institut Català d'Oncologia - Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain.
University of Alabama at Birmingham, Biochemistry and Molecular Genetics, Birmingham, Alabama, USA.
Vaccine. 2013 Dec 31;31 Suppl 7(Suppl 7):H1-31. doi: 10.1016/j.vaccine.2013.10.003.
Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. In recent years, we have gained tremendous knowledge about HPVs and their interactions with host cells, tissues and the immune system; have validated and implemented strategies for safe and efficacious prophylactic vaccination against HPV infections; have developed increasingly sensitive and specific molecular diagnostic tools for HPV detection for use in cervical cancer screening; and have substantially increased global awareness of HPV and its many associated diseases in women, men, and children. While these achievements exemplify the success of biomedical research in generating important public health interventions, they also generate new and daunting challenges: costs of HPV prevention and medical care, the implementation of what is technically possible, socio-political resistance to prevention opportunities, and the very wide ranges of national economic capabilities and health care systems. Gains and challenges faced in the quest for comprehensive control of HPV infection and HPV-related cancers and other disease are summarized in this review. The information presented may be viewed in terms of a reframed paradigm of prevention of cervical cancer and other HPV-related diseases that will include strategic combinations of at least four major components: 1) routine introduction of HPV vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread-optimally universal-implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph 'Comprehensive Control of HPV Infections and Related Diseases' Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters.
人乳头瘤病毒（HPV）感染已被确认为全球与感染相关癌症的主要病因之一，也是其他疾病的致病因素。国际癌症研究机构（IARC）已经明确指出 HPV 与宫颈癌、阴茎癌、外阴癌、阴道癌、肛门癌和口咽癌（包括舌底和扁桃体）之间存在因果关系。在 2008 年全球估计发生的 1270 万例新癌症中，有 4.8%归因于 HPV 感染，发展中国家的发病率和死亡率明显高于发达国家。近年来，我们对 HPV 及其与宿主细胞、组织和免疫系统的相互作用有了深入的了解；验证并实施了针对 HPV 感染的安全有效的预防性疫苗接种策略；开发了越来越敏感和特异的 HPV 分子诊断工具，用于宫颈癌筛查；极大地提高了全球对 HPV 及其在妇女、男子和儿童中多种相关疾病的认识。尽管这些成就体现了生物医学研究在产生重要公共卫生干预措施方面的成功，但也带来了新的、令人畏惧的挑战：HPV 预防和医疗保健的成本、技术上可行的实施、对预防机会的社会政治抵制，以及国家经济能力和医疗保健系统的广泛差异。本综述总结了在寻求全面控制 HPV 感染和 HPV 相关癌症及其他疾病方面取得的成果和面临的挑战。所呈现的信息可以从预防宫颈癌和其他 HPV 相关疾病的重新构建的范例来看待，该范例将包括至少四个主要组成部分的战略组合：1）在所有国家向妇女常规引入 HPV 疫苗，2）使用 HPV 技术扩展和简化现有的筛查计划，3）将适应性筛查计划扩展到发展中人群，4）考虑 HPV 疫苗在妇女以及男子中可预防的更广泛的癌症和其他疾病谱。尽管已经取得了巨大的进展，但必须持续努力，包括国际宣传，以在发达国家和发展中国家广泛实施 HPV 预防策略。本文总结了 2012 年《人乳头瘤病毒感染与相关疾病的综合控制》专论疫苗增刊第 30 卷中各章提出的信息。关于每个子主题的更多详细信息和关于支持文献的完整信息可在原始章节中找到。
