淺談子宮頸癌與人類乳突病毒

The Correlation between Cervical Cancer and Human Papilloma Virus Infection

子宮頸癌的死亡率在全世界婦女癌症排名第四。流行病學的研究顯示，人類乳突病毒的感染是造成子宮頸癌的主要原因，目前已知的人類乳突病毒有兩百多種基因型，其中有四十多種人類乳突病毒基因型會對女性之生殖道，如子宮頸、陰道和外陰等造成病變與癌症，其中可依罹癌的風險分成高風險型及低風險型，高風險型包含有 16、18、31、33、35、39、45、51、52、56、58、59、66 與 68 等型別，以 16 型及 18 型最常見，約佔了 70%。目前子宮頸抹片與人類乳突病毒基因型已被廣泛利用為子宮頸癌篩檢的工具，再加上台灣食品藥物管理署已核准子宮頸癌疫苗Cervarix®、Gardasil® 及 Gardasil® 9 上市，希望透過疫苗的施打，預防高風險型HPV 的感染，而降低子宮頸癌的發生率，也期望民眾能夠透過定期子宮頸癌篩檢，早期發現癌前病變而早期治療。本文將透過前人的研究，討論子宮頸癌與人類乳突瘤病毒之間的相關性。

The mortality rate of cervical cancer ranks fourth among cancers in women worldwide. Molecular epidemiological studies show that almost all cervical cancers are caused by human papillomavirus (HPV). More than 200 genotypes of HPV have been identified, and more than 40 HPV genotypes are transmitted through sexual behavior. Based on their oncogenic potential, they are divided into two groups: low-risk and high-risk genotypes of HPV. The 14 genotypes of high-risk HPV (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) are of the most concern. Two of these, HPV genotypes 16 and 18, are the most dangerous, since they cause about 70 percent of cervical cancers. In gynecologic cancer, cervical cancer is the easiest to prevent by regular screening tests. In Taiwan, two screening tests can help prevent cervical cancer or find it early, including Pap smears, which look for precancers, and cell changes on the cervix that might become cervical cancer. Second, the HPV genotyping test looks for viruses that can cause these cell changes. The Taiwan Food and Drug Administration (FDA) has approved three prophylactic HPV vaccines to prevent HPV infection: Gardasil®, Gardasil® 9, and Cervarix®. These vaccines provide strong protection against high risk HPV infections, but they are not effective at treating established HPV infections or diseases caused by HPV. Therefore, HPV vaccines reduce the risk of cervical cancer, and periodic screening schedules are important interventions for cervical cancer prevention even after HPV vaccines are introduced. Both methods can be very effective in reducing cervical cancer incidence and mortality. This paper summarizes the previous studies of the causal relation between human papillomavirus and cervical cancer