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Zervixkarzinom

Risikofaktoren, Früherkennung und primäre Prävention

Cervical cancer

Risk factors, early detection and prevention

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Die Onkologie Aims and scope

Zusammenfassung

Mit über einer halben Million Neuerkrankungen und mehr als 300.000 Todesfällen pro Jahr ist das Zervixkarzinom die vierthäufigste Krebserkrankung der Frau weltweit. In Deutschland wurden 2019 etwa 4575 Neuerkrankungen und 1600 Todesfälle gezählt. Dem Karzinom gehen höhergradiger zervikale intraepitheliale Neoplasien (CIN 2/3) voraus. Durch die frühzeitige Diagnose und Behandlung dieser Läsionen kann die Entstehung eines Karzinoms verhindert werden. Mit der Einführung von Früherkennungsprogrammen auf der Grundlage zytologischer Abstriche konnte in den letzten 50 Jahren in Ländern mit hohem Einkommen die Inzidenz und Mortalität des Zervixkarzinoms mehr als halbiert werden. Man kann daher mit Recht sagen, dass die Einführung des zytologischen Screenings eine der erfolgreichsten präventivmedizinischen Maßnahmen in der Medizin darstellt [4, 29]. Fast immer stellen Hochrisikosubtypen des humanen Papillomavirus (HPV) die Ursache für die Entstehung eines Zervixkarzinoms und seiner Vorgängerläsionen dar. Dieses Wissen hat das Konzept der Früherkennung dahingehend verändert, dass die HPV-Testung mittlerweile weltweit eine bedeutende Rolle in Screeningprogrammen einnimmt [10, 31]. Neben der High-Risk-HPV-Infektion sind auch andere virusunabhängige Risikofaktoren, wenn auch in weitaus geringerem Maße, zu berücksichtigen. Hierzu zählen u. a. Immundefizienz, Multiparität, langjährige Einnahme oraler Antikonzeptiva und Rauchen. Die Entstehung eines Zervixkarzinoms ist weitgehend vermeidbar. Durch die HPV-Impfung von Mädchen und Jungen vor ihrem ersten sexuellen Kontakt könnte bei Impfraten über 70 % die Erkrankung zu einem sehr seltenen Ereignis werden. So treten 90 % der Zervixkarzinome in Ländern mit niedrigem und mittlerem Einkommen auf. Bei fehlenden Möglichkeiten der Etablierung systematischer Früherkennungsprogramme wäre auch hier, wie von der Weltgesundheitsorganisation (WHO) gefordert, die Implementierung umfassender Impfprogramme ein bedeutender Schritt nach vorn.

Abstract

With over half a million new cases and more than 300,000 deaths per year, cervical cancer is the fourth most common cancer in women worldwide. Higher-grade cervical intraepithelial neoplasia (CIN 2/3) precedes cancer. Early diagnosis and treatment of these lesions can prevent the development of cancer. With the introduction of screening programs based on cytological smears, the incidence and mortality of cervical cancer has decreased by more than half over the last 50 years in high-income countries. It is therefore fair to say that the introduction of cytological screening is one of the most successful preventive medical interventions in medicine. High-risk subtypes of the human papillomavirus (HPV) are almost always the cause of cervical cancer and its precursor lesions. This knowledge has changed the concept of early detection to the extent that HPV testing now plays an important role in screening programs worldwide. In addition to high-risk HPV infection, other virus-independent risk factors must also be considered, albeit to a much lesser extent. These include immunodeficiency, multiparity, long-term use of oral contraceptives, and smoking. The development of cervical cancer is largely preventable. HPV vaccination of girls and boys before their first sexual contact could, with vaccination rates above 70%, make the disease a very rare event. However, because 90% of cervical cancers occur in low- and middle-income countries and due to the absence of opportunities to establish systematic screening programs, the implementation of comprehensive vaccination programs would also be a significant step forward here, as called for by the World Health Organization (WHO).

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Correspondence to Julia Gallwas.

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Gallwas, J. Zervixkarzinom. Onkologie 29, 932–943 (2023). https://doi.org/10.1007/s00761-023-01380-3

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