Servikal Kanser Kontrolünde Human Papilloma Virüs Ýnfeksiyonlarýna Karþý Aþýlama

Cervical cancer is the second most common malignant neoplasm affecting women woridwide that remains an important pub-lic health. Ýn the past several years, there have been substantial advances in our understanding of the epidemiology of cervical carcinogenesis and the causal role of oncogenic human papillomavirus (HPV). Despite this scientific progress, cervical cancer continues to have a devastating impact on women worldwide, with an estimated 400.000 women deveioping cervical cancer and 200.000 dying from this disease each year. VVÝdespread programmatic or opportunistic screening with the Papanicoiau cytoiogy tecnique has likely contributed to reducing about three-fourths of the cervical cancer burden in high-income countries during the last 50 years. However, in deveioping countries that have not implemented screening programmes for cervical cancer, the effect of a drop in rates of cervical cancer. Establishment of the link between HPV and cervical cancer has provided the impetus for re-search into prophylactic vaccination against the most common HPV types associated with the disease. Initial studies have provided evidence that L1 virus-like partcle vaccines against HPV 16 and HPV 18 (as monovaient, bivalent, or quadrivalent vacci-nes) prevent at least 90% of incident and persistent infections and their associated precursors of cervical cancer. Larger phase ili trials of vaccines targeted against different oncogenic HPV types are unden/vay. A combined strategy of vaccination for pri-mary prevention of oncogenic HPV infection and cervical cytologic screening for secondary prevention of cervical cancer offers an intriguing option to further reduce the mortality from invasive cervical cancer. Hovvever, such implementation will need defini-tion of the vaccine’s effect on public health, cost-effectiveness, the optimum age for vaccination, and the duration of protection.

Vaccination Against Human Papillomavirus Infection in Cervical Cancer Control

Serviks kanseri, dünyada kadýnlarý etkileyen kanserler içinde 2. sýrada yer alarak hâlâ önemli bir halk saðlýðý problemini oluþturmaktadýr. Son yýllarda, serviks kanserinin epidemiyolojisi ve onkojenik human papilloma virüsün (HPV) rolüne dair bilgilerimizde belirgin geliþmeler olmuþtur. Bu bilimsel geliþmelere raðmen, sen/iks kanseri dünyada yýkýcý etkisini sürdürmektedir. Her yýl 400.000 kadýnda serviks kanseri geliþirken, 200.000 kadýn bu hastalýktan ölmektedir. Son 50 yýl içinde yüksek geliþmiþlik düzeyindeki ülkelerde Papanicoiau sitoloji test ile yapýlan yaygýn taramalar, serviks kanser zararýný dörtte üç oranýnda azaltmýþtýr. Bununla beraber, geliþmekte olan ülkelerde servikal kanser için tarama programlarý ile serviks kanser hýzýndaki düþüþ istenilen düzeyde olmamýþtýr. HPV ve servikal kanser arasýndaki iliþkinin gösterilmesi, hastalýkta görülen en yaygýn HPV tiplerine karþý profilaktik aþý araþtýrmalarýna ivme kazandýrmýþtýr. HPV 16 ve 18’i içeren L1 virüs benzeri aþýlarýn, sen/iks kanserine sebep olan infeksiyonlarýn en az %90'ýný önlediði gösterilmiþtir. Farklý onkojenik HPV tiplerine karþý daha geniþ Faz III çalýþmalar devam etmektedir. Onkojenik HPV tiplerinin primer önlenmesinde aþýlama ve sekonder korumada servikal sitoloji taramasýnýn bir arada kullanýldýðý stratejiler invaziv serviks kanserinden ölümleri azaltacaktýr. Ancak aþýnýn insan saðlýðý üzerine etkileri, etkinlik-mali-yet analizi, aþýlama için en uygun yaþ ve koruma süresinin tanýmlanmasýna ihtiyaç olacaktýr.