HPV-FASTER: broadening the scope for prevention of HPV-related cancer
HPV-FASTER: broadening the scope for prevention of HPV-related cancer
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DOI：
10.1038/nrclinonc.2015.146
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发表时间：
2016-02-01
影响因子：
78.8
通讯作者：
Cuzick, Jack
中科院分区：
文献类型：
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作者：
Xavier Bosch, F.;Robles, Claudia;Cuzick, Jack
人乳头瘤病毒相关筛查技术和人乳头瘤病毒疫苗接种为预防癌症，特别是预防宫颈癌提供了巨大潜力。然而，由于筛查计划的实施有限，HPV疫苗接种的适应症有限，这些方法的有效性并不理想。在55岁以下的女性中进行的HPV疫苗接种试验显示，在HPV 16/18-DNA阴性的女性中，HPV 16/18引起的宫颈癌前病变的保护率几乎达到90%。我们建议将常规疫苗接种计划扩展到30岁以下的女性（在某些情况下，45-50岁年龄组），并在30岁或以上时进行至少一次HPV筛查试验。扩大HPV疫苗接种的适应症，并在筛查方案中更多地使用HPV检测，有可能加速宫颈癌发病率的下降。这种综合议定书对许多卫生保健系统来说是一种有吸引力的办法，特别是对中欧和东欧、拉丁美洲、亚洲和非洲一些较发达地区的国家。年龄> 30岁的妇女接种疫苗的作用和接种疫苗的妇女所需的HPV筛查试验的最佳数量仍然是重要的研究问题。成本效益模型将有助于确定公共卫生计划中HPV疫苗接种和筛查的最佳组合，并估计这些方法在不同人群中的效果。
Human papillomavirus (HPV)-related screening technologies and HPV vaccination offer enormous potential for cancer prevention, notably prevention of cervical cancer. The effectiveness of these approaches is, however, suboptimal owing to limited implementation of screening programmes and restricted indications for HPV vaccination. Trials of HPV vaccination in women aged up to 55 years have shown almost 90% protection from cervical precancer caused by HPV16/18 among HPV16/18-DNA-negative women. We propose extending routine vaccination programmes to women of up to 30 years of age (and to the 45-50-year age groups in some settings), paired with at least one HPV-screening test at age 30 years or older. Expanding the indications for HPV vaccination and much greater use of HPV testing in screening programmes has the potential to accelerate the decline in cervical cancer incidence. Such a combined protocol would represent an attractive approach for many health-care systems, in particular, countries in Central and Eastern Europe, Latin America, Asia, and some more-developed parts of Africa. The role of vaccination in women aged > 30 years and the optimal number of HPV-screening tests required in vaccinated women remain important research issues. Cost-effectiveness models will help determine the optimal combination of HPV vaccination and screening in public health programmes, and to estimate the effects of such approaches in different populations.