Zhang Shaokai, Xu Huifang, Zhang Luyao, Qiao Youlin
Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou 450008, China.
Department of Epidemiology, National Cancer Center, Chinese Academy of Medical Sciences, School of Population Medicine and Public Health, Peking Union Medical College, Beijing 100021, China.
Chin J Cancer Res. 2020 Dec 31;32(6):720-728. doi: 10.21147/j.issn.1000-9604.2020.06.05.
Cervical cancer is one of the leading causes of cancer death among females worldwide and its behavior epidemiologically likes a venereal disease of low infectiousness. Early age at first intercourse and multiple sexual partners have been shown to exert strong effects on risk. The wide differences in the incidence among different countries also influenced by the introduction of screening. Although the general picture remains one of decreasing incidence and mortality, there are signs of an increasing cervical cancer risk probably due to changes in sexual behavior. Smoking and human papillomavirus (HPV) 16/18 are currently important issues in a concept of multifactorial, stepwise carcinogenesis at the cervix uteri. Therefore, society-based preventive and control measures, screening activities and HPV vaccination are recommended. Cervical cancer screening methods have evolved from cell morphology observation to molecular testing. High-risk HPV genotyping and liquid-based cytology are common methods which have been widely recommended and used worldwide. In future, accurate, cheap, fast and easy-to-use methods would be more popular. Artificial intelligence also shows to be promising in cervical cancer screening by integrating image recognition with big data technology. Meanwhile, China has achieved numerous breakthroughs in cervical cancer prevention and control which could be a great demonstration for other developing and resource-limited areas. In conclusion, although cervical cancer threatens female health, it could be the first cancer that would be eliminated by human beings with comprehensive preventive and control strategy.
宫颈癌是全球女性癌症死亡的主要原因之一，其流行病学行为类似于传染性较低的性病。首次性交年龄早和多个性伴侣已被证明对风险有很大影响。不同国家发病率的巨大差异也受到筛查引入的影响。尽管总体情况仍然是发病率和死亡率下降，但由于性行为的变化，宫颈癌风险有增加的迹象。吸烟和人乳头瘤病毒（HPV）16/18目前是子宫颈多因素、逐步致癌概念中的重要问题。因此，建议采取基于社会的预防和控制措施、筛查活动以及HPV疫苗接种。宫颈癌筛查方法已从细胞形态观察发展到分子检测。高危HPV基因分型和液基细胞学是常见方法，已在全球范围内广泛推荐和使用。未来，准确、廉价、快速且易于使用的方法将更受欢迎。人工智能通过将图像识别与大数据技术相结合，在宫颈癌筛查中也显示出前景。同时，中国在宫颈癌防治方面取得了众多突破，可为其他发展中及资源有限地区提供很好的示范。总之，尽管宫颈癌威胁女性健康，但它可能是人类通过综合防治策略能够消除的第一种癌症。
