高峰論壇I:人類乳突病毒(HPV)疫苗
Human papillomavirus (HPV) vaccine

程 序 表

I-1
Epidemiology of HPV infection and burden of HPV-related diseases
陳慧祺
台大醫學院婦產科

  Human papillomavirus (HPV) infection is well-recognized as one of the major causes of infection-related cancer in both men and women. High-risk HPV types are not only responsible for virtually all cervical cancer cases but also for a fraction of cancers of the vulva, vagina, penis, anus, and head and neck cancers. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). In 2012, approximately 4.5% (640,000 cases) of new cancer cases were attributable to HPV infection.
  HPV was ascribed for 29.5% of infection-related cancers worldwide in 2012 and caused more than half of all infection-attributable cancers in women (570,000 cases), in which cervical cancer accounts for more than 80% of cases
  Furthermore, HPV is also the cause of anogenital warts and recurrent respiratory papillomatosis.
  The most updated data estimating HPV infection among women with normal cervical cytology is based on systematic reviews and meta-analysis performed by the Institut Catal_a d’Oncologia (ICO)/IARC Information Centre on HPV and Cancer. The global prevalence of HPV infection is estimated as 11.7% (95% confidence interval: 11.6e11.7), although there are considerable regional differences and substantial variations from study to study. Particularly high prevalence of HPV infection is seen in
  Africa and Oceania. However, the vast majority of HPV infections (70e90%) are asymptomatic and transient (resolve spontaneously in 1e2 years).
  Globally, the highest HPV prevalence is observed at young ages. As a result, in all world regions HPV prevalence peaks in women less than 25 years (24.0%; 23.5-24.5) and then declines in older ages. In Europe and Americas, a clear decline with age is observed. No such clear decline with age is found in Africa and Asia. Further, in some regions such as Western Africa, and Central and South America, a modest second peak of HPV detection is observed in older women.
  Globally, HPV16 is the most frequent oncogenic type, detected in 3.2% of women with normal cytology, followed by HPV18 (1.4%), HPV52 (0.9%), HPV31 (0.8%), and HPV58 (0.7%), in specific order, although regional differences in the HPV ranking are observed. The unique and importance roles of HPV58 and HPV52 infection were especially addressed in Asian countries, as well as in Taiwan.
  Nearly 10 years, the promising HPV vaccines and HPV-DNA screening were widely introduced to the campaigns to HPV- related diseases in those developed countries.