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Prävention von Zervix- und Vulvakarzinomen

Prevention of cervical and vulvar cancer

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Der Gynäkologe Aims and scope

Zusammenfassung

Für die Entwicklung des Zervixkarzinoms ist die persistierende Infektion mit den humanen Papillomviren (HPV) Voraussetzung. Die Inzidenz ist in Deutschland mit etwa 6500 Neuerkrankungen im Vergleich mit anderen westeuropäischen Ländern noch relativ hoch. Die beiden Hochrisiko-HPV-Typen 16 und 18 sind für über 70% aller weltweit auftretenden Zervixkarzinome verantwortlich. Die primäre Prävention kann daher durch eine HVP-Vakzinierung erzielt werden. Durch „virus-like particles“ (VLP; synthetische, leere Virushüllen) wird eine anhaltende Immunität gegen das HPV-Hüllprotein L1 induziert, also eine Wirksamkeit gegen durch die Impfstoff-HPV-Typen induzierten Zervix- und Vulvaneoplasien. Da nicht alle HPV-Typen durch die Impfstoffe erfasst werden, ist die Teilnahme an den regelmäßigen Krebsfrüherkennungsuntersuchungen weiterhin wichtig. Diese sekundäre Prävention wird bisher mittels des zytologischen Abstrichs durchgeführt. Der HPV-Test weist als alternative Screeningmethode in umfangreichen Studien eine bessere Sensitivität auf als der Pap-Test. Dünnschichtzytologie und der neu verfügbare p16-ELISA (für Frauen unter 35 Jahren) sind in Diskussion. Die Inzidenz der VIN 2/3 als Präkanzerose des Vulvakarzinoms hat sich in den letzten Jahren verdoppelt. Die primäre Prävention des Vulvakarzinoms kann zumindest für die HPV-assoziierten Fälle einschließlich deren Vorstufe VIN 2/3 durch die HPV-Vakzinierung erzielt werden.

Abstract

Persistent human papilloma virus (HPV) infection is the most important factor in the development of cervical cancer. The incidence in Germany remains relatively high in comparison with other Western European countries, with ca. 6,500 new cases per year. The high-risk HPV types 16 and 18 are responsible for over 70% of all cases of cervical cancer worldwide. Primary prevention can be achieved by HPV vaccination. A humoral immune response against HPV outer capsid protein L1 can be induced by so- called virus-like particles (VLP: empty, synthetic virus capsids), with attaining 100% seroconversion and almost complete prevention of persistent infection and, cervical and vulvar neoplasias caused by these HPV types. As not all HPV types are included in the vaccine, it is still important to undergo regular, early cancer early detection examinations. Until now this secondary prevention has meant cytologic screening followed by colposcopic work up and, eventually, therapy. Loop electrical excision of the transformation zone (LEEP) is the standard treatment method for CIN. As an alternative screening method, HPV testing has proven to be more sensitive compared tothan conventional pap smears screening. Liquid-based cytology and p16 ELISA enzyme-linked immunosorbent assaytesting, the latter for women under 35 years of age, are under discussion. The incidence of VIN vulvar intraepithelial neoplasia 2/3 as precancerous lesions has doubled. Primary prevention of vulvar neoplasia by HPV vaccination has been shown to be effective by HPV vaccination, at least for HPV-associated cases. Early detection can be accomplished by diagnosis of premalignant vulvar changes within the regular yearly cancer detection program.

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Interessenkonflikt

Der Autor hat in den letzten 5 Jahren Vortrags-, Beratungshonorare und Reisekostenunterstützung erhalten und war an Studien mehrerer Firmen beteiligt, die im Bereich HPV, Zervixkarzinom, Molekulardiagnostik, Zytologie und Vakzine tätig sind.

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  1. Direktor der Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    P. Hillemanns

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Correspondence to P. Hillemanns.

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Hillemanns, P. Prävention von Zervix- und Vulvakarzinomen. Gynäkologe 41, 500–507 (2008). https://doi.org/10.1007/s00129-008-2145-5

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