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Epidemiologie, Prävention und Früherkennung des Zervixkarzinoms

Epidemiology, prevention and early detection of cervical cancer

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Persistierende Infektionen mit humanen Papillomaviren (HPV) sind die notwendige Ursache des Zervixkarzinoms. Die Entwicklung von HPV-basierten Präventionsverfahren, der HPV-Impfung und der HPV-Testung, führt derzeit zu umfangreichen Veränderungen von Zervixkarzinom-Vorsorgeprogrammen. Eine Dekade nach Einführung der HPV-Imfpung in vielen Ländern werden bereits Reduktionen von HPV-Infektionen und Krebsvorstufen bei jungen Frauen beobachtet. Der Fokus liegt jetzt auf der Integration von neuen Testverfahren im Screening von Populationen mit zunehmenden Impfraten.

Ergebnisse und Schlussfolgerung

Ein erfolgreiches Zervixkarzinom-Vorsorgeprogramm besteht aus verschiedenen Komponenten, vom primären Screening über die Triage zur Kolposkopie mit Biopsie, um Frauen mit Kresbvorstufen zu identifizieren, die eine therapeutische Intervention benötigen. Im primären Screening wird eine kleine Gruppe von Frauen mit erhöhtem Risiko für eine Krebsvorstufe identifiziert, während die große Mehrheit kein erhöhtes Risiko hat. Je nach primärem Testverfahren werden in im Screening positiv-befundeten Frauen zusätzliche Triage-Tests durchgeführt, um zu entscheiden, wer zur Kolposkopie überwiesen werden sollte. Derzeit gibt es drei verschiedene Ansätze für das primäre Zervixkarzinomscreening: die Zervix-Zytologie, die HPV-Testung, und die HPV-Zytologie-Kotestung. Zahlreiche Triage-Tests für HPV-positive Frauen werden derzeit untersucht, darunter die Zytologie, HPV-Genotypisierung, p16/Ki-67 Zytologie und diverse Methylierungstests. Die steigende Anzahl an Optionen für die Früherkennung des Zervixkarzinoms stellt eine Herausforderung für klinische Leitlinien dar. Die zunehmende Komplexität von Vorsorgeprogrammen kann zur Verunsicherung von Ärzten und von am Screening teilnehmenden Frauen führen. Die Präzisionsprävention des Zervixkarzinoms ist eine neuer Ansatz, der umfangreiche Risikodaten, basierend auf der individuellen Vorgeschichte und von Testergebnissen, integriert und einheitliche, risikobasierte Managementempfehlungen gibt.

Abstract

Background

Persisting infections with human papillomaviruses (HPV) are the indisputable cause of cervical cancer. The development of HPV-based preventive procedures, HPV vaccination and HPV testing are currently leading to major changes in cervical cancer prevention programs worldwide. A reduction of HPV infections and cancer precursors has been observed for young women in many countries one decade after the introduction of HPV vaccination. The focus is now on the integration of new testing approaches for screening of populations with increasing vaccination rates.

Results and conclusion

A successful cervical cancer prevention program consists of various components including primary screening, triage of screening positives and colposcopy with biopsy to identify women with precursor cancer stages who require treatment. The role of primary screening is to identify a small subset of women with an increased risk of a precancerous stage, while the majority of women can be reassured that the risk is very low. Depending on the primary screening test, additional triage testing is required to decide who should be referred for colposcopy. Currently, there are three major approaches to cervical cancer screening: cervical cytology, HPV testing and HPV cytology co-testing. Several triage tests for HPV-positive women are currently being evaluated, including cytology, HPV genotyping, p16/Ki-67 cytology and various methylation tests. The increasing number of options for cervical cancer screening represent a challenge for clinical guidelines to remain up to date and comprehensible. The increasing complexity can lead to confusion among providers and women who participate in screening programs about the best approaches. Precision prevention is a novel approach to cervical cancer screening that integrates comprehensive risk data based on the individual medical history with test results for uniform, risk-based management decisions.

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Authors and Affiliations

  1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, MD 20892-9774, Medical Center Drive, Room 7‑E114, 9609, Bethesda, USA

    Nicolas Wentzensen

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Correspondence to Nicolas Wentzensen.

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Interessenkonflikt

N. Wentzensen ist Angestellter des National Cancer Institutes (NCI). Das NCI hat Assays für das Zervixkarzinomscreening zu reduzierten Kosten von den Firmen BD, Cepheid, Hologic, und Roche erhalten. Darüber hinaus bestehen keine Interessenkonflikte.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Wentzensen, N. Epidemiologie, Prävention und Früherkennung des Zervixkarzinoms. Onkologe 22, 725–736 (2016). https://doi.org/10.1007/s00761-016-0092-7

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