Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
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DOI：
10.1093/annonc/mdq162
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发表时间：
2010-05-01
影响因子：
50.5
通讯作者：
Castiglione, M.
中科院分区：
文献类型：
--
作者：
Haie-Meder, C.;Morice, P.;Castiglione, M.
欧盟的宫颈癌粗发病率为13.2/10万，粗死亡率为5.9/10万妇女/年。全世界每年新增宫颈癌病例近50万例，造成27.4万人死亡。宫颈癌是导致女性死亡的第三大常见原因。与发达国家相比，发展中国家的死亡率高出10倍，因为发展中国家的妇女往往无法获得筛查和治疗方案，因此∼80%的新病例发生在发展中国家。大多数欧盟成员国的筛查能力令人满意，即使根据现有筛查登记册的数据，筛查测试在所有方案中的覆盖率为80%，从10%到79%不等。最近有证据表明，初次性交和早孕是发展中国家宫颈癌的危险因素。性传播人乳头瘤病毒的高危持续感染几乎是所有宫颈癌病例的原因。HPV-16和HPV-18是最常见的致癌类型。除了包括常规巴氏涂片和HPV DNA检测在内的筛查技术外，现在还可以通过接种HPV疫苗进行初级预防。疫苗的高效可能会极大地减少宫颈癌，预防高达70%的新诊断病例。然而，疫苗的成本阻碍了它的广泛实施，并可能增加与发展中国家的死亡率差异。
The crude incidence of cervical cancer in the European Union is 13.2/100 000 and the crude mortality rate is 5.9/100 000 women/year. Nearly 500 000 cervical cancer new cases are occurring worldwide each year, responsible for 274 000 deaths. Cervical cancer represents the third most common cause of female mortality. The mortality is 10 times higher in developing countries, where∼ 80% of new cases occur, compared with developed countries, since screening and treatment programmes are frequently inaccessible to women in developing countries. The screening capacity is satisfactory in most European Union member states, even if, based on data from available screening registers, the coverage of the screening test is< 80% in all programmes, ranging from 10% to 79%. Early age at first sexual intercourse and early pregnancies have been recently evidenced as risk factors for cervical cancer in developing countries. High-risk persistent infection with sexually transmittable human papillomavirus is responsible for virtually all cases of cervical cancer. HPV-16 and HPV-18 are the most prevalent of the oncogenic types. In addition to screening techniques including conventional Papanicolaou smear and HPV DNA testing, primary prevention via vaccination against HPV is now available. The high efficacy of the vaccines may dramatically decrease cervical cancer, preventing up to 70% of newly diagnosed cases. The cost of the vaccine, however, precludes its widespread implementation and may increase the difference in mortality with developing countries.