Please share your oppinion:

请分享你的观点

Recently I noticed this topic in another cytology website in China. Let us have a discussion here.

最近我在另一个中国的细胞学网站中注意到这个主题。让我们一起在这里讨论。

1. Are all cervical carcinoma related to HPV infection?

所有的宫颈癌都是由HPV导致的吗？

2. When the women or who should have high risk HPV (hrHPV) testing?

那些女性需要或者什么时候做高危HPV检测呢？

3. What methods to detect hrHPV do you used in your hospitals?

你们医院用的是那种方法检测高危HPV？

4. What should the women do if she has positive hrHPV result?

如果她的高危HPV的结果是阳性的，她们该怎么办？

5. hrHPV testing should be performed for women with AGC?

细胞学结果为AGC的女性应该进行高危的HPV检测吗？

6. Any question, experience or oppinion you have, please share or discuss.

所有以上问题，就你个人的观点或经验来分享和讨论吧。

We as pathologists should know some basic information about HPV even though HPV testing might not be oerformed in your hospital, or the patients might not be able to pay for the test.

 即使HPV检测在你们医院没有开展或病人没有经济能力支付这项检测。我们做为病理学医生应该知道一些关于HPV的基本知识。 

Brief information about HPV 

        Circular DNA virus

 “其实对于HPV检测对宫颈癌的意义；我个人人为象乙肝病毒的检测对于乙型肝炎所致的肝癌一样；乙肝病毒的检测多少年了；但是还是有那么多得乙型肝炎的病人；HPV的疫苗的效果可能还不一定赶得上乙肝疫苗（这需要几十年之后来评价）；因为HPV的变种比乙肝病毒的变种多；但是HPV的感染途径相对困难；所以没有乙肝病毒感染那么高。 ”

个人认为，HPV之于宫颈癌与HBV对于肝癌目前有个明显的不同之处在于：HPV引起宫颈癌有个明确的较长时间的癌前病变阶段，从而使得宫颈癌的二级预防得以实现。HBV疫苗的广泛使用，使得乙型肝炎所致的肝癌的一级预防得以实现；如果HPV疫苗能够得到应用，将会使得宫颈癌的一级预防成为现实。

还是常规的有规律的细胞学检查更重要，完全可以掌握它的发展程度，如果形态学上无进展，则可不予理睬，如果达到了手术指征，则手术治疗。

The AP (7/8) reports, "GlaxoSmithKline PLC said Tuesday a study shows its human papillomavirus vaccine Cervarix was effective against the types of HPV that are most likely to cause cervical cancer, but also fought other strains of the disease." A study of 18,644 women showed that "women who received all three doses of the vaccine provided 92.9 percent protection, and GlaxoSmithKline said there was also evidence the vaccine protects against HPV types 31, 33, and 45." Results of the study "were published in The Lancet."

        According to the Dow Jones Newswires (7/8, Stovall), the "study showed for the first time for any cervical cancer vaccine that Cervarix provided significant cross-protection against pre-cancerous lesions not containing the two most common virus types, the UK-based drugmaker said." The Phase III trial, which involved women "aged between 15 and 25 years, from 14 countries across Europe, Asia-Pacific and Latin and North America," also indicated that "additional efficacy could translate into approximately 11 percent to 16 percent extra protection against cervical cancer over and above the protection afforded by efficacy against the two most common types alone."

        Reuters (7/8) also notes that the study's researchers said the only efficient way to stop the virus is to also vaccinate boys and men.

 大家好，我是个新人，看到这个讨论，也有些自己的想法，不知道是否对

1,HPV的感染是宫颈癌的发生原因之一，但是否感染了宫颈癌就一定会患宫颈癌呢？就算是高危型的，我想也是反复多次的感染才有一定几率转化为宫颈癌吧，那这样的话，把HPV检测作为普查的手段，就算你检出阳性，意义又有多大呢？

2.就算检出阳性，临床又能如何处理呢？现在对于抗病毒的治疗，效果都很有限吧，至于所谓的HPV疫苗，难道不会像流感的疫苗一样？病毒的变异很快的吧，谁知道将来又会不会变异出另一些高致病性的HPV呢？

3.相对于PAP检测而言，对于最终宫颈癌的检出率上，HPV的检测又能有多大的提高呢？我所知的国外很多地方甚至都在采用传统刮片，发TBS报告，而不是用现在这些名目繁多的什么液基薄层手段。那我想，相对于这些辅助的手段而言，提高我们自身的诊断水平，是否更迫切更重要呢？

 提高我们自身的诊断水平，是否更迫切更重要呢？

Totally agree. It is very important for pathologists to improve the diagnostic level.

 Good points.

HPV 16/18 account for about 70-80% of cervical cancer.

Current vaccine

HPV L1 VLP vaccine profiles

	Gardasil™ (Merck)	Cervarix™ (GlaxoSmithKline)
L1 VLP Antigens	HPV6 20 g	HPV16 20 g
	HPV 11 40 g	HPV 18 20 g
	HPV 16 40 g
	HPV 18 20 g
Expression system	Yeast (Saccharomyces cerevisiae)	Baculovirus
Adjuvant	Proprietary aluminum hydroxyphosphate Sulfate (225 g)	ASO4 aluminum  hydroxide (500 g)  plus 50 g 3-deacylated monophosphoryl lipid A
Injection volume and immunisation schedule	0.5 ml i.m. 0, 2  and 6 months	0.5 ml i.m. 0, 1    and 6 months
Adolescent safety/immunogenicity bridging trials	Females and males 9–15 years	Females 10–14 years
		Males 10–18 years (in progress)
	Licensed	License application made

 i.m.=intramuscular.

 HPV 16/18 account for about 70-80% of cervical cancer.

Above two vaccines include only HPV 16/18.

 翻译108楼

HPV 16/18 包括70-80%的宫颈癌

目前疫苗

HPV  L1壳蛋白疫苗概况

Gardasil™（默克）                           Cerarix（葛兰素史克）

HPV  L1壳蛋白抗体        

HPV6 20 g                                                 

HPV 11 40 g 

HPV16 40 g                                           

 HPV 18 20 g

                                                     HPV 16 20 g

                                                     HPV 18 20 g

佐        剂                  特制羟基磷酸盐硫酸铝225 g                               ASO4氢氧化铝500g，

                                                                                                             加上50g3 - deacylated单磷酰脂A  

注射量和免疫接种时间表   

                                   0.5毫升肌注0 、2和6个月                                 0.5毫升肌注0、1和6个月              

    

青少年安全/免疫原性桥连试验

                                   女性和男性9—15岁                                        女性10—14岁，男性10—18岁（过程中）

                                        持证件                                                               持申请许可证

i.m.=肌肉注射

 In fact now some people suggest to use HPV testing as primary screening test. I paste the figs here. The chart figs are from this paper 

Vaccine. 2008 Aug 19;26 Suppl 10:K29-41 Comment in: Vaccine. 2008 Dec 9;26(52):6743-4.

Overview of human papillomavirus-based and other novel options for cervical cancer screening in developed and developing countries.Cuzick J, Arbyn M, Sankaranarayanan R, Tsu V, Ronco G, Mayrand MH, Dillner J, Meijer CJ.

Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, London, United Kingdom. jack.cuzick@cancer.org.uk

名称：图1
描述：图1

名称：图2
描述：图2

名称：图3
描述：图3

Fig 2:Proposed potential future screening algorithm. This algorithm employs HPV testing as the primary test and uses cytology to triage HPV positive women to eliminate short follow up group. Triage with p16 and mRNA may also be useful, but this is less well established.

 Fig 3: Proposed HPV DNA-based screening algorithm for developing countries

When people talk about cervical cancer screening issue, they always treat China as a developing country.

We have very compicated feeling when we as Chinese American physicians abroad read, know the current cervical ca screening situation in China.

The purpose that I send the proposal for HPV screening here is just to let our young pathologists in China know the new issue in this area. In fact I do not like the proposal , at least now.

The AP (7/9) reported, "The World Health Organization has approved a second cervical cancer vaccine," Cervarix, "made by GlaxoSmithKline, meaning UN agencies and partners can now officially buy millions of doses of the vaccine for poor countries worldwide." The organization "had previously approved Gardasil, a competing cervical cancer vaccine made by Merck & Co. With two cervical cancer vaccines now ready to be bought by donor agencies, officials estimate that tens of thousands of lives might be saved." Data show that over "80 percent of the estimated 280,000 cervical cancer deaths a year occur in developing countries. In the West, early diagnosis and treatment has slashed the disease's incidence." But, Dan Thomas, a spokesman for the Global Alliance for Vaccines and Immunization (GAVI), pointed out that "the vaccines typically cost about $360 for a three-shot dose -- which is far too expensive for poor countries."

        According to Dow Jones Newswires (7/9, Stovall), "Just how the Cervarix deliveries will be paid for has yet to be worked out." In a statement, GlaxoSmithKline said, "We're eager to work with our long-term partner GAVI, as well as other private NGOs or governments of developing countries to identify financing mechanisms for the vaccine." Both Cervarix and Gardasil "are designed to prevent infection by human papillomavirus, or HPV, the virus that causes cervical cancer. Reuters (7/9, Hirschler) also covered the story.