Chapter 29: Knowledge gaps and priorities for research on prevention of HPV infection and cervical cancer.
Chapter 29: Knowledge gaps and priorities for research on prevention of HPV infection and cervical cancer.
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第 29 章：HPV 感染和宫颈癌预防研究的知识差距和重点。
DOI：
10.1016/j.vaccine.2006.06.038
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发表时间：
2006
期刊：
影响因子：
5.5
通讯作者：
Wright,ThomasC
中科院分区：
文献类型：
--
作者：
Franco,EduardoL;Bosch,FXavier;Cuzick,Jack;Schiller,JohnT;Garnett,GeoffreyP;Meheus,Andre;Wright,ThomasC
人类乳头瘤病毒(HPV)感染是宫颈癌的必然原因，这一认识为筛查和HPV免疫接种带来了新的预防模式。我们现在面临着如何实施一项雄心勃勃的以证据为基础的宫颈癌预防议程的许多问题。人们对HPV感染的流行病学和自然病史了解很多，但仍有几个关键变量有待阐明。对HPV传播的研究需要新的研究设计，以提供对预防策略的有用见解。HPV检测已经在临床实践中开辟了一个利基市场，但要巩固其在筛查中的作用，仍需要有长期受益的证据。快速发展的HPV诊断领域为HPV分型的价值提供了有用的信息。其他筛查方法在特定环境下前景看好。将HPV疫苗带到公共卫生应用家门口的长达十年的过程已经结束。关于长期疗效、保护的相关性、接种疫苗的年龄和接生仍然存在许多问题。随着疫苗接种作为一种癌症控制战略取得进展，必须重新制定筛查做法，以最大限度地发挥一级预防和二级预防之间的协同作用。关于如何实现这些模式的有效组合的研究尚未开始，但数学模型已经为有希望的算法的现场测试提供了有用的路线图。在向最需要疫苗的人群提供疫苗方面，令人生畏的问题迫在眉睫。人乳头瘤病毒和宫颈癌预防领域从未像现在这样多学科。一个新时代已经开始，挑战也很多。
The recognition that human papillomavirus (HPV) infection is the necessary cause of cervical cancer brought new prevention paradigms in screening and HPV immunization. We now face many questions about how to implement an ambitious evidence-based agenda for cervical cancer prevention. Much is known about the epidemiology and natural history of HPV infection but several key variables remain to be elucidated. Research on HPV transmission requires new study designs to provide useful insights into preventive strategies. HPV testing has carved a niche in clinical practice but to consolidate its role in screening still requires evidence of long-term benefit. The rapidly evolving field of HPV diagnostics has contributed useful information concerning the value of HPV typing. Other screening methods hold promise in specific settings. The decade-long process that brought HPV vaccines to the doorstep of public health application is over. Many questions remain concerning long-term efficacy, correlates of protection, age of vaccination, and delivery. As vaccination makes inroads as a cancer control strategy, screening practices must be reformulated to maximize the synergy between primary and secondary prevention. Research on how to achieve an efficient combination of these modalities is yet to begin, but mathematical models have provided a useful road map for field-testing of promising algorithms. Daunting questions loom large concerning delivery of vaccines to those populations that need it the most. The field of HPV and cervical cancer prevention has never been so multi-disciplinary. A new era has begun and the challenges are many.