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子宮頸癌防治

子宮頸癌防治. 子宮頸抹片 子宮頸癌疫苗. Global mortality per annum. < 3.9. < 7.9. < 14.0. < 23.8. < 55.6. Worldwide, every 2 minutes a woman dies of cervical cancer 1

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子宮頸癌防治

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  1. 子宮頸癌防治 • 子宮頸抹片 • 子宮頸癌疫苗

  2. Global mortality per annum < 3.9 < 7.9 < 14.0 < 23.8 < 55.6 • Worldwide, every 2 minutes a woman dies of cervical cancer1 • The highest burden of disease (up to 80%) occurs in less developed regions1 where there is a lack of effective screening programmes • This demonstrates a clear medical need for new cervical cancer interventions Europe 60,000 new cases 30,000 deaths North America 14,500 new cases 6,000 deaths Asia 266,000 new cases 143,000 deaths Latin America 72,000 new cases 33,000 deaths Africa 79,000 new cases 62,000 deaths Cervical cancer mortality rates worldwide Cases per 100,000 women per year 1. Ferlay J, et al. GLOBOCAN 2002 Cancer Incidence, Mortality and Prevalence Worldwide. IARC CancerBase; Lyon, 2004.

  3. Top 10 Cancer Incidence in Taiwan, 2007 資料來源：國民健康局 http://www.bhp.doh.gov.tw; 台灣癌症登記小組 http://crs.cph.ntu.edu.tw

  4. 暫 時 性 感染 (Transient Infection) 人類乳突病毒感染 癌 前 期 病 變 癌 症 持 續 性 感 染 (Persistent Infection) (若發生在子宮頸即稱為子宮頸上皮病變) (若發生在子宮頸即稱為子宮頸癌) 子宮頸癌的防治 其他因素 子宮頸抹片 衛教: 單純性伴侶 預防人類乳突病毒感染

  5. 子宮頸癌防治 • 全體醫護人員的協助與努力。 • 提升子宮頸抹片檢查之百分比，33%  70~80%。

  6. 子宮頸抹片的限制：定期性、偽陰性、難發現腺癌子宮頸抹片的限制：定期性、偽陰性、難發現腺癌 可能有問題、卻未發現— 抹片平均約有15-20％的偽陰性率 女性「抹」不到的痛— 99.2％的子宮頸腺癌發現已為侵襲癌 腺癌發生處 • 民國95年共有4,644位子宮頸鱗狀細胞癌案例 • 3,255例為原位癌，佔70% • 1,389例發現時已為侵襲癌，佔了30% • 民國95年共有249位子宮頸腺癌案例 • 僅2例為原位癌 • 247例發現時已為侵襲癌，佔了99.2% 抹片處

  7. 人類乳突病毒(HPV)是什麼？ • HPV(人類乳突病毒)是一種比細菌還小的微生物，屬於濾過性病毒的一種。 Nonenveloped double-stranded DNA virus

  8. Vaccines to prevent HPV infection Jian Zhou • Cancer associated Human Papillomaviruses • (~1980) • Two capsid proteins (L1, L2) • Virus can’t be grown in the lab • Infection poorly immunogenic • Virus Like particles1 • (~1990) • L1 capsid protein • rDNA technology • eukaryotic cells • Self assembly to VLPs • VLPs highly immunogenic • HPV vaccines • (~2005) • -Conventional vaccines • VLPs+ adjuvant • Neutralising Ab • Protection > 5yrs • Safe 1:J. Zhou, X. Y. Sun, D. J. Stenzel, and I. H. Frazer. Virology 185 (1):251-257, 1991.

  9. HPV Infection From Time of First Sexual Intercourse 少女(單一性伴侶)感染HPV的累積風險(UK,1988-1992)a 70 60 50 40 30 20 10 0 0 12 24 36 45 60 女中學生統計 (US,1990-2000)b 70 N=242 N=603 60 40 感染HPV的累積風險(%) 感染HPV的累積風險(%) 20 0 0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 月份(性交後計起) 月份(性交後計起)月份(性交後計起) Adapted from Winer, et al. Adapted from Collins, et al. a) Collins S, Mazloomzadeh S, Winter H, et al. BJOG. 2002;109:96–98. b) Adapted from Winer RL, Lee S-K, Hughes JP, Adam DE, Kiviat NB, Koutsky LA. Genital human papillomavirus infection: Incidence and risk factors in a cohort of female university students. Am J Epidemiol. 2003;157:218–226, by permission of Oxford University Press.

  10. Prevalence of HPV Infection Among Females in the United States—the highest between 20-24 y/o Dunne EF, et al JAMA 2007; 297:813-9

  11. 台灣子宮頸癌HPV型別 60-70% 28-32%

  12. HPV Types in Cervical Cancer 53.5% 16 70.7% + 18 77.4% + 45 81.3% + 31 88.1% 85.0% + X 87.9% + 33 90.1% + 52 91.8% + 58 93.3% + 35 94.6% + 59 95.7% + 56 0 20 40 60 80 100 Proportion of cancers associated with HPV types Munoz N, Bosch FX, de Sanjose S et al,. N Engl J Med 2003; 348: 518–27.

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