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Worldwide, about 500,000 new cases and 300,000 women die every year. There are about10.5 million new cases in China every year, and the trend is younger. The incidence of cervical cancer in young women is increasing by 2%-3% every year.
Cervical cancer is the only cancer with a definite cause, which can be prevented at an early stage. Preventing human papillomavirus infection is the main way to prevent and treat cervical cancer.
Relationship between human papillomavirus and cervical cancer and characteristics of human papillomavirus infection
Human papillomavirus is widely spread in the population, and 40% of women will be infected with human papillomavirus in the first two years of sexual life. However, in the first year of human papillomavirus infection, 70% of the virus was automatically eliminated by the immune system, 90% of the virus was eliminated in the first two years, and almost 5% of the virus turned into persistent infection after three years, and then developed into cervical cancer. Under the influence of continuous infection of human papillomavirus, the whole process from cervical precancerous lesion to cervical cancer may take 10-30 years.
Cervical cancer is the most common cancer among adult women in China. If found early, it can be almost 100% cured. The difficulty is that the woman herself will not feel that she has stage zero cancer, so it depends on cervical cytology. Among them, the easiest way to check the mass is cervical smear. However, the reliability of smear examination is not very high. Fortunately, it usually takes at least seven years for normal cervix to develop into zero-stage cancer, and it takes ten years for zero-stage cancer to develop into invasive cancer. Therefore, patients with problems should be diagnosed if they have been examined every year for more than ten years. Before zero-stage cancer, smear examination will be divided into three reports: (1) normal or inflammatory; (2) low-risk population; (3) high-risk groups. For the last two reports, we still need to use colposcopy to check the problematic places and even do biopsy. Other examination methods include fluorescence reaction and biopsy.
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Cervical cancer can be described as a killer of beautiful women. Li Yuanyuan, Anita Mui and other beautiful female stars are all caused by cervical cancer? Fragrant? The disease is also the second most common cancer among women aged 15 ~ 44 in China, with about130,000 new cases every year.
Every year, China accounts for more than 28% of cervical cancer cases in the world. Globally, a new case is found every minute on average, and a woman dies of cervical cancer every two minutes.
New cases of cervical cancer in China account for about 12% of the world. According to the World Cancer Report of WHO in 2065,438+04, it is estimated that there will be about 62,000 new cases of cervical cancer in China in 2065,438+02, with a total incidence of 9.4/654,380+million people/year. Although the incidence rate is lower than the average level in East Asia and the world, due to the large population base in China, the number of new patients accounts for 12% of the world every year.
Although most cancers can't find a specific cause, fortunately, cervical cancer has found a clear cause. Persistent high-risk virus infection is the most important pathogenic factor leading to cervical squamous cell carcinoma and its precancerous lesions, and almost all people (>: 99.9%) have high-risk virus infection.
HPV 16 and 18 in the human papillomavirus family are most closely related to the occurrence of malignant tumors, resulting in more than 70% of cervical cancer, 80% of anal cancer, 60% of vaginal cancer and 40% of vulvar cancer. Human papillomavirus 45 and human papillomavirus 3 1 cause 5% and 10% of cervical cancer, respectively.
So cervical cancer is a special kind? Infectious diseases? . Infectious diseases are easy to handle, and the epidemic of infectious diseases must have three basic links: the source of infection, the route of transmission and the susceptibility of the population. Three links must exist at the same time to constitute the epidemic of infectious diseases. Without any of them, there will be no new infection, and it is impossible to form an epidemic.
How to prevent infectious diseases?
The method is also simple, isolating the source of infection, cutting off the route of transmission and protecting the susceptible population.
How to prevent human papillomavirus infection, cervical lesions and even cervical cancer?
First, check regularly, and the screening strategy is as follows.
20 16, 16 10. In October, ACOG (American College of Obstetricians and Gynecologists) issued a practical guide for cervical cancer screening and prevention (ACOG Practice BulletinNo. 157, OBT et gynecol.2016; ; 127: 185-7.),
1. It is emphasized that cervical cancer screening should start from 2 1 year. Regardless of the age of women's first sexual life or other behavioral risk factors, women younger than 2 1 are not screened, except for women infected with HIV. If young women are infected with human papillomavirus, almost all of them can rely on the immune system to clear the virus within 1-2 years without forming tumors. Screening before the time suggested by the guidelines may increase patients' anxiety, prevalence and cost, and lead to excessive follow-up.
2.2 1-29-year-old women should have a cytological examination alone and be screened once every three years. It is not necessary to have a cervical cancer screening every year. Women under the age of 30 don't need a joint examination. Women aged 30-65 suggest that cytology and human papillomavirus should be examined once every five years; It is also feasible to have a separate cytological examination every three years without annual screening.
3. For patients who have completely negative previous screening and have no CIN2 (cervical intraepithelial neoplasia grade 2) or higher, all forms of screening should be stopped after the age of 65. The so-called all negative results of previous screening are defined as three consecutive cytological negative results or two combined screening negative results in the past 10 years, and the latest examination was within 5 years. Women with a history of CIN2, CIN3 (cervical intraepithelial neoplasia grade 3) and AIS (cervical adenocarcinoma in situ) should continue to be screened for 20 years after CIN2, CIN3 and AIS naturally subside or get proper treatment, even if they are over 65 years old.
4. For women who have undergone total hysterectomy and have no CIN2 or above lesions in the past, routine cytological examination and human papillomavirus detection should be stopped, and there is no reason to start again.
5. Women with the following high-risk factors may need more frequent screening than recommended by traditional screening guidelines, which are aimed at women with average risk:
1) women infected with HIV; 2) Women with low immune function (such as those receiving solid organ transplantation); 3) Women exposed to diethylstilbestrol in utero; 4) Women who have received CIN2, CIN3 or cancer treatment before.
Treatment of abnormal results of joint screening;
1. The risk of CIN3 is very low for women with negative cytology ASCUS and human papillomavirus in the joint examination, but the risk is still slightly higher than that of women with negative joint screening. It is recommended to conduct joint screening within 3 years.
Women aged 2.30 and above who are negative for human papillomavirus in comprehensive screening should be treated in one of the following two ways:
(1) 12 months. If the repeated cytological examination is ASCUS or higher, or the human papillomavirus is still positive, the patient should be advised to undergo colposcopy. Otherwise, patients should be jointly screened within 3 years.
(2) The typing test of human papillomavirus-16 and human papillomavirus-18 should be conducted immediately. If human papillomavirus-16 and/or human papillomavirus-18 are positive, colposcopy should be performed directly. If both subtypes of human papillomavirus are negative, the combined screening should be repeated within 12 months, and the results should be treated according to the management guidelines for abnormal cervical cancer screening results revised by 20 12 SCCP.
Second, find cervical diseases and treat them in time.
The canceration process of human papillomavirus is not in one step, but the cycle of continuous infection with precancerous lesions by human papillomavirus is usually about ten years. Therefore, as long as women have a sense of self-care and do regular check-ups, most of them can prevent or find cervical precancerous lesions, treat them in time, plan ahead, and block cervical cancer in the cradle of precancerous stage.
Third, the vaccination of HPV vaccine: At present, it is considered that the protection rate of vaccine is above 70-80%. It is estimated that the incidence of cervical cancer will decrease significantly after 20 years of comprehensive vaccination. Before this day comes, cervical cancer screening is still the best way to prevent cervical cancer, and screening recommendations have nothing to do with the vaccination status of human papillomavirus.
The most popular human papillomavirus vaccine being studied in the world has only three members, namely bivalent, tetravalent and nonavalent vaccines. Price? Represents the type of virus that the vaccine can prevent.
1, bivalent vaccine Cervarix？
More than 70% of cervical cancer is caused by HPV 16 and HPV 18! The bivalent vaccine can prevent cervical cancer caused by HPV 16 and HPV 18 lesions. From 2065438 to July 2006, bivalent vaccine sirrah became the first lucky person to enter the China market.
2. Tetravalent vaccine
It can prevent human papillomavirus types 6, 1 1, 16 and 18. Although HPV6 and HPV 1 1 are not high-risk HPV viruses for cervical cancer, they do cause condyloma acuminatum and vulvar cancer? The culprit? . Tetravalent vaccine? Gardesi? (Jiadaxiu) also entered the China market in June 20 17.
3. Nine-valent vaccine
According to the nine subtypes of HPV6, 1 1, 16,18,31,33,45,52,58, it is said that 90% of cervical cancer can be prevented! Nine-valent vaccine has not been allowed to enter the China market.
Fourth, keep the vulva clean and avoid infection. Actively treat gynecological inflammation such as vulvitis and vaginitis.
Five, healthy and harmonious sex life, avoid multiple sexual partners, the husband has the same responsibility.
6. Maintaining a cheerful and optimistic attitude, good living habits and quitting smoking (known factors that can increase the persistent infection of human papillomavirus include smoking, immune system suppression and HIV infection) are conducive to maintaining immunity and preventing cancer and diseases.
Preventing cervical cancer seems simple? Simple! Is it difficult to implement? Need the persistence of friends who love health. Adhere to healthy living habits, vaccinate and cooperate with regular cervical cancer screening. I believe it is not impossible to eliminate cervical cancer one day!
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Homosexual bleeding is one of the most common symptoms of cervical cancer. Early cervical cancer or precancerous lesions even have no symptoms, which requires routine cervical cancer screening to eliminate them in the bud.
So, how to do a good job in cervical cancer screening?
The trilogy of cervical cancer screening teaches you to effectively prevent cervical cancer.
(a) the first step of cervical cancer screening:
1, cervical and vaginal cytology:
TCT (liquid-based thin-layer cytological picture technique of cervical cancer) is an advanced cytological examination technique of cervical cancer in the world. Compared with the traditional pap smear examination of cervical cancer, it obviously improves the detection rate of abnormal cervical cells. The doctor put the collected cells into a specimen bottle with cell preservation solution and sent them to the laboratory. The production process is controlled by computer programs. Pathologists can see at a glance that the diagnostic rate of cervical cancer, especially precancerous lesions, is obviously improved.
2. HPV DNA detection: HPV DNA detection is a genetic detection method to predict the risk coefficient of cervical cancer according to HPV typing. At present, it has been confirmed that human papillomavirus infection is the main cause of cervical cancer and its precancerous lesions, and human papillomavirus can be found in 99.8% of cervical cancer patients.
3. Screening method:
(1) screening age: cervical cancer screening should start about 3 years after sexual life begins, generally no later than 2 1 year, and screening can be terminated over 65 years old.
(2) Time interval of screening: 1 time/year. Those who are normal for three consecutive times can be appropriately extended to 2-3 years before screening.
(2) The second step of cervical cancer screening:
Colposcopy: Colposcopy is an enlarged endoscope between the naked eye and a low-power microscope. It is a method of clinical diagnosis by directly observing the morphological structure of vascular epithelium on the cervical surface.
When cervical cytology finds abnormalities, colposcopy is needed to determine the lesions.
(3) The third step of cervical cancer screening:
Cervical biopsy: the most reliable method to diagnose cervical precancerous lesions and cervical cancer. Any macroscopic lesion should be biopsied at one or more points to make a definite diagnosis and take effective treatment measures as soon as possible.
Because cervical cancer has a long and reversible precancerous lesion, early detection and timely treatment can effectively prevent the occurrence of cervical cancer. One of the key points of cervical cancer prevention is to strengthen regular physical examination, and strive for early detection of tumors and treatment. Early cervical cancer often does not have any uncomfortable symptoms. It is impossible to find abnormalities simply by the appearance of the cervix, and it must be understood through cell-level examination. When the tumor develops to the advanced stage, there may be bleeding, increased leucorrhea after sexual life, pain, and even the possibility of involving surrounding organs. The effect of treating advanced tumors is relatively poor.