Prevention of cervical cancer: basic principles.
Cervical cancer (cervical cancer) is one of the leading causes of death among women. According to the World Health Organization (WHO), 604,000 cases of the disease were detected in 2020, the death rate from breast cancer was 304,000 people. Screening programs are being developed worldwide in order to reduce the mortality from breast cancer. Since the middle of the XX century, the main method of early diagnosis of breast cancer is a cytological examination using the PAP test (PAP test), but since then, screening programs have been supplemented and expanded.
The main etiological factor in the development of breast cancer is human papillomavirus (HPV). The oncogenic subtypes of this virus, HPV16 and HPV18, are especially dangerous, they account for about 70% of all cases of breast cancer. In this regard, in most of the recommendations of the world communities, the method of primary screening is the determination of HPV DNA.
For example, in the American recommendations of 2020, screening at the age of 21 to 24 years is impractical. At the age of 25 to 65 years, it is recommended to conduct an HPV DNA test every 5 years. Alternatively, it is acceptable to simultaneously conduct an HPV test and a PAP test every 5 years or conduct a PAP test every 3 years. In earlier versions of the recommendations, the HPV test was not used at the age of 25 to 29 years. At the age of over 65 years, it is possible to stop screening in the absence of previously positive test results. In case of suspicion of the presence of malignant neoplasms, the second stage is recommended to conduct a colposcopy with a biopsy.
According to the Russian recommendations, women aged 18 years and older are recommended to have a gynecological examination 1 time a year. Women aged 18 to 64 years inclusive are recommended to take a smear from the cervix, cytological examination of a smear from the cervix 1 time every 3 years.
In recent years, HPV vaccination programs have been implemented in many countries around the world. Vaccination is recommended to be carried out at the age of 11 to 12 years, it is possible to safely use the vaccine from the age of 9. According to the Cochrane review, the incidence of precancerous diseases in young women in the vaccinated group was 2 per 10,000 and 164 per 10,000 in the placebo group.
The high efficiency and low cost of breast cancer screening and HPV vaccination makes it necessary to introduce them all over the world.
The information was prepared by GUZOT "Tsozimp"
based on the materials of the Federal State Budgetary Institution "NMIC TPM" of the Ministry of Health of the Russian Federation
