Cervical cancer is one of the common gynecological malignant tumors. Its incidence rate ranks second among female malignant tumors in my country, behind breast cancer . In 2018, there were more than 569,000 new cases of cervical cancer and more than 311,000 deaths worldwide. 85% of these cases occur in developing countries. In 2015, there were approximately 111,000 new cases and 34,000 deaths in my country.
The median age of onset of cervical cancer in my country is 51 years old, but it mainly occurs in two age groups, with the most common among 40 to 50 years old. There is a peak at 60 to 70 years old, and it is rare before the age of 20. However, it is worth noting that the average age of onset of cervical cancer has been gradually decreasing in recent years, with a trend of getting younger. Vaccines are an important means of preventing cervical cancer.
Cervical cancer vaccine , to be precise, it should be called human papillomavirus (HPV) vaccine. It can not only prevent cervical cancer, but also prevent cervical precancerous lesions , genital warts, anal cancer , oropharyngeal cancer, Vulvar cancer , vaginal cancer and penile cancer .
What is HPV?
HPV is a DNA virus that reproduces by lodging in the cells of the human body. As a disease that easily infects human epidermis and mucosal squamous epithelium, HPV is mainly sexually transmitted and enters the reproductive tract, mouth or throat, causing mucosal and skin infections. Infection may also occur through direct contact. For example, after touching HPV-contaminated items with hands, the virus may be introduced into the reproductive organs when using the toilet or bathing, or the reproductive organs may come into contact with underwear, etc., and the infection may also occur. In short, HPV is very transmissible.
HPV infection is not easy to detect, and many people do not know they are infected. Nearly all cases of cervical cancer are related to HPV infection. HPV viruses can be divided into carcinogenic (high-risk) and non-carcinogenic (low-risk) types.
The most common high-risk types are HPV16 and HPV18. About 55% to 60% of the causes of cervical cancer are related to HPV16. HPV type 18 ranks second in carcinogenicity and is associated with 10% to 15% of cervical cancers. More than 90% of cervical cancers are related to persistent infection with the two high-risk HPV types.
What is the relationship between HPV and cervical cancer?
It is now clear that persistent high-risk HPV infection is a necessary factor in the occurrence of cervical cancer and precancerous lesions . That is, in the process of cervical cancer, HPV infection is the most critical link.
In a woman’s lifetime, the probability of being infected with high-risk HPV is more than 70%, but less than 10% of women develop cervical cancer or cervical intraepithelial neoplasia (CIN). The main reason is that 80% of women infected with HPV Transient. In addition to the role of persistent high-risk HPV infection,
also requires the participation and action of other endogenous and exogenous factors to cause cervical cancer.
Therefore, the risk factors that cause cervical cancer can be divided into two categories: one is biological factors, that is, persistent infection with high-risk HPV; the other is exogenous behavioral risk factors.
It can be seen that HPV vaccine is of great significance to the prevention of cervical cancer.
What are the HPV vaccines?
The existing HPV vaccines are divided into three types: bivalent vaccine, quadrivalent vaccine, nine-valent vaccine .
How protective is the vaccine against cervical cancer?
The HPV vaccine is very popular abroad, and some countries have even listed it as a national plan for mandatory implementation. According to statistics, the bivalent vaccine can reduce the incidence of cervical cancer by about 70%, while the nine-valent vaccine can reduce the incidence by more than 90%.
Real-world research data after the UK launched a universal HPV vaccination program in 2008 showed that after vaccination with the earliest bivalent HPV vaccine on the market, the incidence of cervical cancer and precancerous lesions has dropped significantly, and the earlier the vaccine is administered, the better the protective effect. The better.
How should married women choose the HPV vaccine?
Vaccine selection plans are different for different ages:
🔵 If ≤ 26 years old:
Bivalent, quadrivalent or nine-valent options are available
🔵 If 26 years old:
You can choose bivalent or quadrivalent
🔵 Over 45 years old Vaccination is of little significance for women, and regular screening is recommended.
At the same time, different types of HPV vaccines have different preventive effects. You can choose the corresponding vaccine type according to your own needs based on the content in the table above.
Is it meaningful for married women to get vaccinated?
Married women with children (age ≤ 45 years old) can still receive the HPV vaccine.
Because although having sex, the individual may not have been exposed to HPV. Even if you already have HPV infection, it still makes sense to get the HPV vaccine because the individual may not have been exposed to the types included in the HPV vaccine. Although vaccination does not clear an existing infection, it does protect against infection with another virus subtype or repeated infection with the same virus subtype. In clinical studies, some of the women tested showed that the vaccine was still very effective even though they had already had sexual intercourse.
Vaccination is of little significance for women over 45 years old, and regular screening is recommended.
If you have been diagnosed with cervical cancer, you do not need to get the HPV vaccine.
What are the recommendations for women to get vaccinated?
The World Health Organization recommends that women aged 9 to 45 years old receive the HPV vaccine. The best effect is for women aged to 15 years old to receive the HPV vaccine before having sex for the first time.
Currently, the two peak groups of HPV infection in my country are young women aged 15 to 24 and middle-aged women aged 40 to 45. Based on my country’s national conditions, the National Health Commission recommends HPV vaccination for girls aged 13 to 15 years. The earlier you are vaccinated, the better the protection. As you age, the effectiveness of vaccination will be reduced.
Currently, nine-valent HPV vaccine is hard to find. Many people believe that the higher the “price” number, the more viruses can be prevented. There is some truth to this statement. But when getting vaccinated, you still have to choose the type of vaccine based on your age.
Which groups of people cannot receive the HPV vaccine?
1, The acute phase of severe immunodeficiency disease. Immunosuppression is not a contraindication to HPV vaccination, but if the immune function is low, the immune response will be poor. Therefore, the vaccine can be vaccinated in the non-acute phase when the immunosuppressant is used.
2, Vaccination is not allowed during the acute stage of moderate or severe disease, or during cold or fever with severe infection.
3 and are prohibited for those allergic to protein and yeast.
4, pregnant women .
What are the side effects or adverse reactions after HPV vaccination?
Pain, redness or swelling at the injection site; fever (generally below 38°C); headache or feeling tired; mild nausea; vomiting; muscle or joint pain, all of which are mild. Less commonly, there is also urticaria . In severe cases, there is local edema and blistering.
A few people have experienced adverse reactions such as hypersensitivity reactions after vaccination, and subsequent vaccinations need to be cautious or terminated. Some cases reported abroad about paralysis and other serious consequences caused by the side effects of HPV vaccine are rare phenomena.
Is the HPV vaccine effective for life?
Not necessarily. The HPV vaccine is only a preventive measure, but it does not mean that women who receive the vaccine do not need to undergo cervical cancer screening in the future. There is still a lot of uncertainty as to whether the protective effect of the HPV vaccine can last for life. There are 14 years of statistical data on
related research, showing that the protective effect does not weaken over time. The 14-year data is mainly due to the limited time the vaccine has been on the market. Whether it has a longer protection period or is even effective for life can only be answered by time.
Is it "carefree" after being vaccinated?
Getting the HPV vaccine does not mean "sit back and relax", because there are many HPV subtypes, and regular cervical cancer screening is required after vaccination.
Cervical cancer screening can start 3 years after the start of sexual life or after the age of 21; if cytology and HPV tests are negative, the screening interval can be extended to 3 to 5 years.
After women are over 65 years old, if the screening results are negative for 10 consecutive years and there is no history of cervical intraepithelial neoplasia, screening can be terminated.
The content is synthesized from the "Guidelines for Diagnosis and Treatment of Cervical Cancer (2022 Edition)", Tumor Hospital Affiliated to Fudan University , Tumor Hospital Affiliated to Chongqing University, etc.
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