PRACA POGLĄDOWA
Rak szyjki macicy – czynniki ryzyka i nowe możliwości profilaktyki w Polsce
Więcej
Ukryj
1
Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
2
Prof. K. Gibiński University Clinical Center of the Medical University of Silesia in Katowice, Poland
3
Students' Scientific Society, Department of Gynecology and Obstetrics in Katowice, Medical University of Silesia, Katowice, Poland
4
The Hospital of the Bonifratres of St. John Grand in Cracow, Poland
Autor do korespondencji
Jakub Rybak
Wydział Nauk Medycznych w Katowicach, Śląski Uniwersytet Medyczny
Med Srod. 2023;26(3-4):109-113
SŁOWA KLUCZOWE
DZIEDZINY
STRESZCZENIE
Wprowadzenie i cel:
Rak szyjki macicy jest czwartym pod względem częstości rozpoznań nowotworem wśród kobiet na świecie. W samym 2020 roku odnotowano ponad 604 tys. nowych przypadków zachorowania na ten nowotwór, zaś liczba zgonów wyniosła ponad 340 tys. Pomimo widocznej poprawy w zakresie leczenia tej choroby rak szyjki macicy wciąż stanowi poważny globalny problem. Celem niniejszej pracy jest analiza kluczowych czynników ryzyka związanych z rozwojem raka szyjki macicy, przedstawienie nowych możliwości prewencji tej choroby w Polsce, jak i ocena istniejących już sposobów jej zapobiegania.
Opis stanu wiedzy:
Głównym czynnikiem ryzyka raka szyjki macicy jest zakażenie wirusem HPV. Do rozwoju tego nowotworu predysponują również inne czynniki, takie jak zakażenie HIV i Chlamydia Trachomatis, przyjmowanie doustnych środków antykoncepcyjnych, palenie papierosów czy podejmowanie licznych kontaktów seksualnych. Wywiady przeprowadzone z pacjentkami prowadzą do wniosku, że nawrót raka szyjki macicy często zależy od doświadczenia poronienia, stopnia zaawansowania klinicznego choroby oraz zastosowanego leczenia. Profilaktyka obejmuje szczepienia przeciw HPV, populacyjne badania cytologiczne kobiet oraz testy na obecność HPV. W czerwcu 2023 roku wprowadzono w Polsce możliwość darmowego szczepienia przeciw HPV dla dzieci w wieku 12 i 13 lat.
Podsumowanie:
Rak szyjki macicy wciąż pozostaje poważnym wyzwaniem dla współczesnej medycyny. W ostatnich latach statystyki uległy znacznej poprawie dzięki wprowadzeniu szczepień ochronnych i większej dostępności badań przesiewowych. Program darmowych szczepień w Polsce to kolejny krok w kierunku rozwijania profilaktyki pierwotnej w naszym kraju. Pozostaje mieć nadzieję, że sytuacja na tym polu ulegnie poprawie również w biedniejszych krajach świata.
Introduction and objective:
Cervical cancer is the fourth most frequently diagnosed cancer among women worldwide. In 2020 alone, there were more than 604,000 new cases of this cancer, with a total of more than 340,000 deaths. Despite visible improvements, cervical cancer is still a major global problem. The aim of this review is to analyze the key risk factors associated with the development of cervical cancer, evaluate existing prevention method, and present new opportunities for prevention in Poland.
Brief description of the state of knowledge:
The main risk factor for cervical cancer is HPV infection. Other factors, such as HIV and Chlamydia Trachomatis infection, oral contraceptives, smoking and multiple sexual contacts, also predispose to the development of this cancer. The recurrence of the disease often depends on the presence of a history of miscarriage, tclinical severity and the treatment used. Prevention includes HPV vaccination, population-based cytological screening of women and HPV testing. In June 2023, Poland enabled the possibility of free HPV vaccination for children aged 12 and 13.
Summary:
Cervical cancer remains a major challenge for modern medicine. Statistics have improved significantly in recent years due to the introduction of immunization and greater availability of screening tests. The free vaccination programme in Poland is another step toward developing primary prevention in our country. It is hoped that the situation will also improve in the poorer countries of the world.
REFERENCJE (48)
1.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209–249. doi:10.3322/caac.21660. Epub 2021 Feb 4. PMID: 33538338.
4.
Shrestha AD, Neupane D, Vedsted P, Kallestrup P. Cervical Cancer Prevalence, Incidence and Mortality in Low and Middle Income Countries: A Systematic Review. Asian Pac J Cancer Prev. 2018 Feb 26;19(2):319–324. doi:10.22034/APJCP.2018.19.2.319. PMID: 29479954; PMCID: PMC5980914.
5.
Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. Lancet. 2019 Jan 12;393(10167):169–182. doi:10.1016/S0140-6736(18)32470-X. PMID: 30638582.
6.
Bedell SL, Goldstein LS, Goldstein AR, Goldstein AT. Cervical Cancer Screening: Past, Present, and Future. Sex Med Rev. 2020 Jan;8(1):28–37. doi:10.1016/j.sxmr.2019.09.005. Epub 2019 Nov 30. PMID: 31791846.
7.
Rerucha CM, Caro RJ, Wheeler VL. Cervical Cancer Screening. Am Fam Physician. 2018 Apr 1;97(7):441–448. PMID: 29671553.
8.
INTERNATIONAL AGENCY FOR RESEARCH ON CANCER, W H O, et al. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. 2012.
9.
Okunade KS. Human papillomavirus and cervical cancer. J Obstet Gynaecol. 2020 Jul;40(5):602–608. doi:10.1080/01443615.2019.1634030. Epub 2019 Sep 10. Erratum in: J Obstet Gynaecol. 2020 May;40(4):590. PMID: 31500479; PMCID: PMC7062568.
10.
Antykoncepcja a nowotwory, Nowa Medycyna 1/2004, Czytelnia Medyczna Borgis, [Internet]. 2023 [cited 2023 December 21] Available at
https://www.czytelniamedyczna.....
11.
Cogliano V, Grosse Y, Baan R, Straif K, Secretan B, El Ghissassi F; WHO International Agency for Research on Cancer. Carcinogenicity of combined oestrogen-progestagen contraceptives and menopausal treatment. Lancet Oncol. 2005 Aug;6(8):552–3. doi:10.1016/s1470-2045(05)70273-4. PMID: 16094770.
12.
Iversen L, Sivasubramaniam S, Lee AJ, Fielding S, Hannaford PC. Lifetime Cancer Risk and Combined Oral Contraceptives: the Royal College of General Practitioners’ Oral Contraception Study. Am J Obstet Gynecol. 2017;216:580.e1–580580.e9. 10.1016/j.ajog.2017.02.002.
13.
International Collaboration of Epidemiological Studies of Cervical Cancer; Appleby P, Beral V, Berrington de González A, Colin D, Franceschi S, Goodhill A, Green J, Peto J, Plummer M, Sweetland S. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet. 2007 Nov 10;370(9599):1609–21. doi:10.1016/S0140-6736(07)61684-5. PMID: 17993361.
14.
Lehtinen M, Ault KA, Lyytikainen E, Dillner J, Garland SM, Ferris DG, Koutsky LA, Sings HL, Lu S, Haupt RM, Paavonen J; FUTURE I and II Study Group. Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia. Sex Transm Infect. 2011 Aug;87(5):372–6. doi:10.1136/sti.2010.044354. Epub 2011 Apr 6. PMID: 21471141; PMCID: PMC3252607.
15.
Yang X, Siddique A, Khan AA, Wang Q, Malik A, Jan AT, Rudayni HA, Chaudhary AA, Khan S. Chlamydia Trachomatis Infection: Their potential implication in the Etiology of Cervical Cancer. J Cancer. 2021 Jun 11;12(16):4891–4900. doi:10.7150/jca.58582. PMID: 34234859; PMCID: PMC8247366.
16.
Aguayo F, Munoz JP, Perez-Dominguez F, Carrillo-Beltrán D, Oliva C, Calaf GM, Blanco R, Nunez-Acurio D. High-Risk Human Papillomavirus and Tobacco Smoke Interactions in Epithelial Carcinogenesis. Cancers (Basel). 2020 Aug 6;12(8):2201. doi:10.3390/cancers12082201. PMID: 32781676; PMCID: PMC7465661.
17.
International Collaboration of Epidemiological Studies of Cervical Cancer; Appleby P, Beral V, Berrington de González A, Colin D, Franceschi S, Goodill A, Green J, Peto J, Plummer M, Sweetland S. Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer. 2006 Mar 15;118(6):1481–95. doi:10.1002/ijc.21493. PMID: 16206285.
18.
Kapeu AS, Luostarinen T, Jellum E, Dillner J, Hakama M, Koskela P, Lenner P, Löve A, Mahlamaki E, Thoresen S, Tryggvadóttir L, Wadell G, Youngman L, Lehtinen M. Is smoking an independent risk factor for invasive cervical cancer? A nested case-control study within Nordic biobanks. Am J Epidemiol. 2009 Feb 15;169(4):480–8. doi:10.1093/aje/kwn354. Epub 2008 Dec 13. PMID: 19074773.
19.
Stelzle D, Tanaka LF, Lee KK, Ibrahim Khalil A, Baussano I, Shah ASV, McAllister DA, Gottlieb SL, Klug SJ, Winkler AS, Bray F, Baggaley R, Clifford GM, Broutet N, Dalal S. Estimates of the global burden of cervical cancer associated with HIV. Lancet Glob Health. 2021 Feb;9(2):e161-e169. doi:10.1016/S2214-109X(20)30459-9. Epub 2020 Nov 16. Erratum in: Lancet Glob Health. 2021 Feb;9(2):e119. PMID: 33212031; PMCID: PMC7815633.
20.
Sarah Maria N, Olwit C, Kaggwa MM, Nabirye RC, Ngabirano TD. Cervical cancer screening among HIV-positive women in urban Uganda: a cross sectional study. BMC Womens Health. 2022 May 10;22(1):148. doi:10.1186/s12905-022-01743-9. PMID: 35538482; PMCID: PMC9092766.
21.
Adler DH, Wallace M, Bennie T, Mrubata M, Abar B, Meiring TL, Williamson AL, Bekker LG. Cervical dysplasia and high-risk human papillomavirus infections among HIV-infected and HIV-uninfected adolescent females in South Africa. Infect Dis Obstet Gynecol. 2014;2014:498048. doi:10.1155/2014/498048. Epub 2014 Oct 20. PMID: 25389377; PMCID: PMC4217359.
22.
Cooper D, Hoffman M, Carrara H, et al. Determinants of sexual activity and its relation to cervical cancer risk among South African women. BMC Public Health. 2007;7:341. doi:10.1186/1471-2458-7-341.
23.
Remschmidt C, Kaufmann AM, Hagemann I, Vartazarova E, Wichmann O, Deleré Y. Risk factors for cervical human papillomavirus infection and high-grade intraepithelial lesion in women aged 20 to 31 years in Germany. Int J Gynecol Cancer. 2013 Mar;23(3):519–26. doi:10.1097/IGC.0b013e318285a4b2. PMID: 23360813.
24.
Louie KS, de Sanjose S, Diaz M, Castellsagué X, Herrero R, Meijer CJ, Shah K, Franceschi S, Munoz N, Bosch FX; International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. Br J Cancer. 2009 Apr 7;100(7):1191–7. doi:10.1038/sj.bjc.6604974. Epub 2009 Mar 10. PMID: 19277042; PMCID: PMC2670004.
25.
Li J, Liu G, Luo J, Yan S, Ye P, Wang J, Luo M. Cervical cancer prognosis and related risk factors for patients with cervical cancer: a long-term retrospective cohort study. Sci Rep. 2022 Aug 17;12(1):13994. doi:10.1038/s41598-022-17733-8. PMID: 35978078; PMCID: PMC9385852.
28.
Osowiecka K, Yahuza S, Szwiec M, Gwara A, Kasprzycka K, Godawska M, Olejniczak D, Nowacka A, Nowakowski JJ, Nawrocki S, Rucinska M. Students’ Knowledge about Cervical Cancer Prevention in Poland. Medicina (Kaunas). 2021 Sep 30;57(10):1045. doi:10.3390/medicina57101045. PMID: 34684082; PMCID: PMC8539101.
30.
Centers for Disease Control and Prevention. Vaccination Schedules & Recommendations. [Internet] 2023 [cited 2023 October 8] Available at:
https://www.cdc.gov/hpv/hcp/sc....
31.
Bruni L, Diaz M, Barrionuevo-Rosas L, Herrero R, Bray F, Bosch FX, de Sanjosé S, Castellsagué X. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. Lancet Glob Health. 2016 Jul;4(7):e453–63. doi:10.1016/S2214-109X(16)30099-7. Erratum in: Lancet Glob Health. 2017 Jul;5(7):e662. PMID: 27340003.
32.
Castle PE, Maza M. Prophylactic HPV vaccination: past, present, and future. Epidemiol Infect. 2016 Feb;144(3):449–68. doi:10.1017/S0950268815002198. Epub 2015 Oct 2. Erratum in: Epidemiol Infect. 2016 Aug;144(11):2472. PMID: 26429676.
33.
Guevara AM, Suarez E, Victoria A, Ngan HY, Hirschberg AL, Fedrizzi E, Bautista O, Shields C, Joshi A, Luxembourg A. Maternal transfer of anti HPV 6 and 11 antibodies upon immunization with the 9-valent HPV vaccine. Hum Vaccin Immunother. 2019;15(1):141–145. doi: 10.1080/21645515.2018.1514227. Epub 2018 Sep 27. PMID: 30261146; PMCID: PMC6363163.
34.
Baussano I, Lazzarato F, Brisson M, Franceschi S. Human Papillomavirus Vaccination at a Time of Changing Sexual Behavior. Emerg Infect Dis. 2016 Jan;22(1):18–23. doi:10.3201/eid2201.150791. PMID: 26691673; PMCID: PMC4696692.
35.
Li N, Franceschi S, Howell-Jones R, Snijders PJ, Clifford GM. Human papillomavirus type distribution in 30,848 invasive cervical cancers worldwide: Variation by geographical region, histological type and year of publication. Int J Cancer. 2011 Feb 15;128(4):927–35. doi:10.1002/ijc.25396. PMID: 20473886.
36.
Obwieszczenie Ministra Zdrowia z dnia 23 lutego 2023 roku w sprawie wykazu zalecanych szczepień ochronnych, dla których zakup szczepionek został objęty finansowaniem. DzU MZ, 2023.16.
37.
Art. 17 ust. 6 w zw. z art. 19 ust. 6 ustawy z dnia 5 grudnia 2008 r. o zapobieganiu oraz zwalczaniu zakażeń i chorób zakaźnych u ludzi (tekst jedn. DzU z 2023 r., poz. 1284).
38.
Medycyna Praktyczna. Zasady szczepienia nastolatków przeciwko HPV w Polsce w ramach programu powszechnego. [Internet] 2023 [cited 2023 October 8] Available at:
https://www.mp.pl/szczepienia/....
39.
Zhang YY, Lu L, Abliz G, Mijit F. Serum carotenoid, retinol and tocopherol concentrations and risk of cervical cancer among Chinese women. Asian Pac J Cancer Prev. 2015;16(7):2981–6. doi:10.7314/apjcp.2015.16.7.2981. PMID: 25854393.
40.
Myung SK, Ju W, Kim SC, Kim H. Korean Meta-analysis (KORMA) Study Group. Vitamin or antioxidant intake (or serum level) and risk of cervical neoplasm: a meta-analysis. BJOG. 2011 Oct;118(11):1285–91. doi:10.1111/j.1471-0528.2011.03032.x. Epub 2011 Jul 12. PMID: 21749626.
41.
Wang J, Elfström KM, Andrae B, Nordqvist Kleppe S, Ploner A, Lei J, Dillner J, Sundström K, Sparén P. Cervical cancer case-control audit: Results from routine evaluation of a nationwide cervical screening program. Int J Cancer. 2020 Mar 1;146(5):1230–1240. doi:10.1002/ijc.32416. Epub 2019 Jun 3. PMID: 31107987; PMCID: PMC7003887.
42.
Torre LA, Siegel RL, Ward EM, Jemal A. Global Cancer Incidence and Mortality Rates and Trends--An Update. Cancer Epidemiol Biomarkers Prev. 2016 Jan;25(1):16–27. doi:10.1158/1055–9965.EPI-15-0578. Epub 2015 Dec 14. PMID: 26667886.
43.
Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER; American Cancer Society; American Society for Colposcopy and Cervical Pathology; American Society for Clinical Pathology. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol. 2012 Apr;137(4):516–42. doi:10.1309/AJCPTGD94EVRSJCG. PMID: 22431528.
44.
Sankaranarayanan R, Nene BM, Shastri SS, Jayant K, Muwonge R, Budukh AM, Hingmire S, Malvi SG, Thorat R, Kothari A, Chinoy R, Kelkar R, Kane S, Desai S, Keskar VR, Rajeshwarkar R, Panse N, Dinshaw KA. HPV screening for cervical cancer in rural India. N Engl J Med. 2009 Apr 2;360(14):1385–94. doi:10.1056/NEJMoa0808516. PMID: 19339719.
45.
Schiffman M, Kinney WK, Cheung LC, Gage JC, Fetterman B, Poitras NE, Lorey TS, Wentzensen N, Befano B, Schussler J, Katki HA, Castle PE. Relative Performance of HPV and Cytology Components of Cotesting in Cervical Screening. J Natl Cancer Inst. 2018 May 1;110(5):501–508. doi:10.1093/jnci/djx225. PMID: 29145648; PMCID: PMC6279277.
46.
Elfström KM, Smelov V, Johansson AL, Eklund C, Nauclér P, Arnheim-Dahlström L, Dillner J. Long term duration of protective effect for HPV negative women: follow-up of primary HPV screening randomised controlled trial. BMJ. 2014 Jan 16;348:g130. doi:10.1136/bmj.g130. PMID: 24435414; PMCID: PMC3898575.
47.
Egemen D, Cheung LC, Chen X, Demarco M, Perkins RB, Kinney W, Poitras N, Befano B, Locke A, Guido RS, Wiser AL, Gage JC, Katki HA, Wentzensen N, Castle PE, Schiffman M, Lorey TS. Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. J Low Genit Tract Dis. 2020 Apr;24(2):132–143. doi:10.1097/LGT.0000000000000529. PMID: 32243308; PMCID: PMC7147417.
48.
Austin RM, Onisko A, Zhao C. Enhanced Detection of Cervical Cancer and Precancer Through Use of Imaged Liquid-Based Cytology in Routine Cytology and HPV Cotesting. Am J Clin Pathol. 2018 Oct 1;150(5):385–392. doi:10.1093/ajcp/aqy114. PMID: 30137189.