Ozawa Nobuyoshi, Ito Kiyoshi, Tase Toru, Metoki Hirohito, Yaegashi Nobuo
Ozawa Women's General Clinic.
Tohoku J Exp Med. 2016 Oct;240(2):147-151. doi: 10.1620/tjem.240.147.
Prevention of cervical cancer has been unsuccessful in Japan because of low rates of cancer screening and vaccination. The Vaccine Adverse Review Committee of the Japanese Government investigated 2,475 adverse events and reported 617 (6.9/100,000) severe cases and 176 (2.0/100,000) cases with chronic pain. The proactive recommendation for human papillomavirus (HPV) vaccination has been suspended since June 2013. In this study, we examined vaccination rate and incidence of abnormal cervical cytology in women aged 20 to 24 years attending cancer screening in Miyagi. Among the 3,272 women who underwent a health check in the fiscal year 2014 (April 2014-March 2015), 332 (10.2%) received a HPV vaccination. The HPV vaccination rates were 42.3%, 10%, 17.5%, 3.8% and 4.0% in women aged 20, 21, 22, 23 and 24 years, respectively. The rates of atypical squamous cells of undetermined significance (ASC-US) or worse were 2.41% (8/332) in women with HPV vaccination and 5.03% (148/2,940) in those without HPV vaccination, indicating a significant decrease in vaccinated women (p = 0.03). ASC-US cases were referred to HPV DNA tests. In addition, the rates of high grade squamous intraepithelial lesion (HSIL) or worse were 0.30% (1/332) in women with HPV vaccination and 0.82% (24/2,940) in those without HPV vaccination, showing the marginal decrease in women who were vaccinated (p = 0.3). Thus, this study indicates that HPV vaccination is associated with a reduction in the incidence of cervical abnormalities, suggesting a need for scientific discussion of reinstatement of proactive recommendation for HPV vaccine in Japan.
由于癌症筛查和疫苗接种率较低，日本的宫颈癌预防工作一直未取得成功。日本政府的疫苗不良反应审查委员会调查了2475起不良事件，报告了617起（6.9/10万）严重病例和176起（2.0/10万）慢性疼痛病例。自2013年6月起，人乳头瘤病毒（HPV）疫苗接种的主动推荐已暂停。在本研究中，我们调查了宫城县参加癌症筛查的20至24岁女性的疫苗接种率和宫颈细胞学异常的发生率。在2014财年（2014年4月至2015年3月）接受健康检查的3272名女性中，332名（10.2%）接种了HPV疫苗。20岁、21岁、22岁、23岁和24岁女性的HPV疫苗接种率分别为42.3%、10%、17.5%、3.8%和4.0%。接种HPV疫苗的女性中意义不明确的非典型鳞状细胞（ASC-US）或更严重病变的发生率为2.41%（8/332），未接种疫苗的女性中这一发生率为5.03%（148/2940），表明接种疫苗的女性发生率显著降低（p = 0.03）。ASC-US病例被转诊进行HPV DNA检测。此外，接种HPV疫苗的女性中高级别鳞状上皮内病变（HSIL）或更严重病变的发生率为0.30%（1/332），未接种疫苗的女性中这一发生率为0.82%（24/2940），表明接种疫苗的女性发生率略有下降（p = 0.3）。因此，本研究表明HPV疫苗接种与宫颈异常发生率的降低有关，这表明有必要对日本恢复HPV疫苗主动推荐进行科学讨论。
