Nowadays, in addition to grabbing mobile phones, grabbing tickets, and grabbing train tickets, there is also a kind of "miao" that makes everyone rush to buy.
Many people can't sleep because they can't grab it.
Helping your girlfriend grab it became a proof of love for her.
This is the HPV nine-valent vaccine.
More and more people are paying attention to the HPV vaccine, which is a good thing.
But at the same time, the nine-valent HPV vaccine is difficult to find, especially in small and medium-sized cities, which has also led to the increase in the price of vaccines in private hospitals, and there are many people who are overly anxious because they have not been given the nine-valent vaccine.
The first thing to be clear is that cervical cancer is very common and must be taken seriously.
The famous Hong Kong artist Mei Yanfang, 38 years old, suffered from cervical cancer, and unfortunately died after 2 years of anti-cancer treatment.
Cervical cancer is the fourth most frequent malignancy among women worldwide [1,2] and the sixth most common malignancy in Chinese women [3].
In 2015, there were 111,000 new cases of cervical cancer nationwide, and about 34,000 cases of cervical cancer died [3].
Cervical cancer is currently the only malignant tumor with an known etiology in the cervix.
Almost all cervical cancers are caused by persistent infection with high-risk human papilloma virus (HPV) [4,5].
HPV is a common sexually transmitted pathogen, and this pathogen is also a large family, with different types of lethality.
About 70% of cervical cancers are caused by high-risk hpv16 and 18 [6]. (HPV types 16 and 18 also cause nearly 90% of anal cancers[8], as well as oropharyngeal, vulvar, vaginal, and penile cancers.)
20% are caused by HPV 31, 33, 45, 52, and 58.[9]
About 10% is caused by other high-risk types of HPV.
HPV types 6 and 11 cause approximately 90 percent of anogenital warts [9].
Therefore, the prevention of HPV infection can also prevent cervical cancer.
Clinically, three different HPV vaccines have been developed, namely bivalent, quadrivalent and nine-valent vaccines.
All three HPV vaccines prevent hpv 16 and 18 types that cause most HPV-related cancers [10].
HPV vaccine type, subtype of coverage, age of vaccination and reference price
▼
The prophylaxis effect after HPV vaccination is very good:
It is possible to prevent more than 90% of hpv-related cancers [11].
Since its introduction, fewer adolescents and young adults have genital warts. Data from the World Center for Disease Control and Prevention (CDC) suggest that since HPV vaccination was first recommended in 2006, HPV-type infections that cause most HPV cancers and genital warts have declined by 88 percent in adolescent girls and 81 percent in young adult women.
It also reduces the incidence of cervical precancerous lesions in young women.
HPV remains strongly protected 12 years after vaccination, and there is no evidence that this protection decreases over time [10].
But we want to say, "Without the nine-valent HPV vaccine≠ can't prevent cervical cancer."
These factors are also worth considering:
Before considering a few valent vaccines, the first thing to consider should be our age.
The World Health Organization (WHO) advocates that the optimal age to vaccinate against HPV is 9-14 years, preferably before sexual activity [12].
Studies have shown that cervical cancer has a lower incidence after HPV vaccination before the age of 17.
Temporally, on the mainland, the first peak age for women to become at high risk of HPV infection is 15 to 24 years of age [13]. HPV vaccination before this age group is the most protective effect.
Regardless of which of the three vaccines is administered, the vaccine stimulates two times as many antibodies in women aged 9–15 years as women aged 16–26 years, meaning the same vaccine is more effective against younger women [14].
So getting the HPV vaccine before the age of 26 is far more important than getting the nine-valent vaccine.
So for women over the age of 26, does the HPV vaccine still work?
Studies have shown that the HPV vaccine can still stimulate antibody production in women over the age of 25 and is safe and effective, with the maximum age at which HPV vaccination is approved in the United States is 45 years.
Three vaccines are not currently available to women over the age of 45 on the mainland, while the nine-valent vaccine is limited to women aged 26 years and younger on the mainland [15].
Sisters between the ages of 27 and 45 who have not yet been vaccinated can choose to get the bivalent or quadrivalent HPV vaccine.
About 84.5% of cervical cancers in mainland China are caused by HPV16 and 18 [16], and bivalent, quadrivalent, and nine-valent HPV vaccines can prevent these two subtypes, which means that most cervical cancers can be prevented.
Antibody responses after bivalent, quadrivalent, and nine-valent vaccinations were excellent, with the proportion of female vaccinators who had more than quadrupled their antibodies after vaccination by more than 93 percent [14].
It can be said that for the prevention of cervical cancer, the bivalent vaccine is a charcoal in the snow, the quadrivalent vaccine is the icing on the cake, and the nine-valent vaccine is excellence.
After considering their age, the supply of vaccines in their cities, their own economic conditions and other factors, bivalent and quadrivalent vaccines are a very cost-effective choice for many sisters.
Whether it is a bivalent, quadrivalent or 9-valent vaccine, a complete vaccination program requires the completion of 3 doses of vaccination (i.e., 3 vaccinations).
But if, for various reasons, the 3rd injection is not given as planned, don't panic, it is also useful!
Studies have shown that 2 or 1 dose of HPV vaccine may also reduce the risk of high-risk HPV subtype infection.
In the case that the objective conditions cannot achieve the completion of 3 doses, even if only 1 dose of the vaccine can be given, it is a blessing in disguise [14].
On November 17, 2020, the WHO released the Global Strategy to Accelerate the Elimination of Cervical Cancer, which has three key elements to eliminate cervical cancer: HPV vaccination, screening and treatment.
HPV vaccination is just one part of the equation, and in addition to vaccines, cervical cancer screening is also a means of reducing the risk of cervical cancer.
Cervical cancer screening is still required after the HPV vaccine has been completed, especially for women who have been sexually exposed to the HPV vaccine.
Regular screening can greatly reduce the risk of cervical cancer.
A randomized trial of more than 130,000 patients in rural India [17] found that even screening for cervical cancer once in a lifetime reduced cervical cancer mortality by 50% compared to no screening.
Existing screening methods include cervical cytology (TCT) and HPV testing [18,19], which can be done in physical examination centers/community health centers/hospitals.
However, the current proportion of cervical cancer screening in the mainland is far from enough. According to the China Center for Disease Control and Prevention Weekly, only 25.7% of women aged 20-64 in mainland China had previously been screened for cervical cancer in 2015 (of which 31.4% were screened for ages 35-64) [20].
National guidelines recommend cervical cytology every 3 years for women aged 21 to 29 years, and a combination of cytology and HPV every 5 years for women aged 30 to 65 years (high-risk groups need to follow doctors' recommendations).
There's a lot more we can do beyond vaccines.
Although the nine-valent HPV vaccine prevents more types of HPV, there is no need to worry if it is not hit.
Bivalent and quadrivalent HPV vaccines are also options, and in addition to vaccines, regular screening can also reduce the risk of cervical cancer.
There is never the only way in the world, prevention is an all-round work, and all roads can lead to the day of KO cervical cancer.
Contributing Author
Lu Xiaohong | Eight-year clinical doctoral student at Peking Union Medical College
Fu Ziyao | Eight-year clinical doctoral student at Peking Union Medical College
Reviewer
Qiao Youlin | Professor and Doctoral Supervisor of the School of Medicine and Public Health, Peking Union Medical College
bibliography
[1] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424. doi: 10.3322/caac.21492. Epub 2018 Sep 12. Erratum in: CA Cancer J Clin. 2020 Jul;70(4):313. PMID: 30207593.
[2] Bruni L, Barrionuevo-Rosas L, Albero G, et al. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human papillomavirus and related diseases in the world: Summary report. December 15, 2016. http://www.hpvcentre.net/statistics/reports/XWX.pdf (Accessed on April 13, 2017).
Li Daojuan, Shi Jin, Jin Jing, et al. Epidemiological trend of cervical cancer[J]. Chinese Journal of Oncology, 2021, 43(09):912-916.
[4] Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, Snijders PJ, Peto J, Meijer CJ, Mu oz N. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999 Sep;189(1):12-9. doi: 10.1002/(SICI)1096-9896(199909)189:13.0.CO;2-F. PMID: 10451482.
[5]https://www.uptodate.cn/contents/zh-Hans/human-papillomavirus-infections-epidemiology-and-disease-associations?search=HPV&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
[6]de Sanjose S, Quint WG, Alemany L, Geraets DT, Klaustermeier JE, Lloveras B, Tous S, Felix A, Bravo LE, Shin HR, Vallejos CS, de Ruiz PA, Lima MA, Guimera N, Clavero O, Alejo M, Llombart-Bosch A, Cheng-Yang C, Tatti SA, Kasamatsu E, Iljazovic E, Odida M, Prado R, Seoud M, Grce M, Usubutun A, Jain A, Suarez GA, Lombardi LE, Banjo A, Menéndez C, Domingo EJ, Velasco J, Nessa A, Chichareon SC, Qiao YL, Lerma E, Garland SM, Sasagawa T, Ferrera A, Hammouda D, Mariani L, Pelayo A, Steiner I, Oliva E, Meijer CJ, Al-Jassar WF, Cruz E, Wright TC, Puras A, Llave CL, Tzardi M, Agorastos T, Garcia-Barriola V, Clavel C, Ordi J, Andújar M, Castellsagué X, Sánchez GI, Nowakowski AM, Bornstein J, Mu oz N, Bosch FX; Retrospective International Survey and HPV Time Trends Study Group. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol. 2010 Nov;11(11):1048-56. Doi: 10.1016/S1470-2045(10)70230-8. Epub 2010 Oct 15. PMID: 20952254.
[7] Serrano B, Alemany L, Tous S, Bruni L, Clifford GM, Weiss T, Bosch FX, de Sanjosé S. Potential impact of a nine-valent vaccine in human papillomavirus related cervical disease. Infect Agent Cancer. 2012 Dec 29;7(1):38. doi: 10.1186/1750-9378-7-38. PMID: 23273245; PMCID: PMC3554470.
[8] Hoots BE, Palefsky JM, Pimenta JM, Smith JS. Human papillomavirus type distribution in anal cancer and anal intraepithelial lesions. Int J Cancer. 2009 May 15;124(10):2375-83. doi: 10.1002/ijc.24215. PMID: 19189402.
[9] Garland SM, Steben M, Sings HL, James M, Lu S, Railkar R, Barr E, Haupt RM, Joura EA. Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis. 2009 Mar 15;199(6):805-14. Doi: 10.1086/597071. PMID: 19199546.
[10]https://www.cdc.gov/vaccines/vpd/hpv/public/index.html
[11] Joura EA, Giuliano AR, Iversen OE, Bouchard C, Mao C, Mehlsen J, Moreira ED Jr, Ngan Y, Petersen LK, Lazcano-Ponce E, Pitisuttithum P, Restrepo JA, Stuart G, Woelber L, Yang YC, Cuzick J, Garland SM, Huh W, Kjaer SK, Bautista OM, Chan IS, Chen J, Gesser R, Moeller E, Ritter M, Vuocolo S, Luxembourg A; Broad Spectrum HPV Vaccine Study. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med. 2015 Feb 19;372(8):711-23. Doi: 10.1056/NEJMoa1405044. PMID: 25693011.
[12] World Health Organization. Vaccine in National Immunization Programme Update[EB/OL] . (2020-06-04) [2020-09-01].
[13] Zhao F, Qiao Y. Cervical cancer prevention in China: a key to cancer control[J]. Lancet, 2019,393(10175):969-970.
[14]https://www.uptodate.cn/contents/zh-Hans/human-papillomavirus-vaccination?search=HPV&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H1664119832
[15]http://www.gov.cn/fuwu/2019-07/09/content_5407517.htm
[16] Chen W, Zhang X, Molijn A, Jenkins D, Shi JF, Quint W, Schmidt JE, Wang P, Liu YL, Li LK, Shi H, Liu JH, Xie X, Niyazi M, Yang P, Wei LH, Li LY, Li J, Liu JF, Zhou Q, Hong Y, Li L, Li Q, Zhou HL, Bian ML, Chen J, Qiao YL, Smith JS. Human papillomavirus type-distribution in cervical cancer in China: the importance of HPV 16 and 18. Cancer Causes Control. 2009 Nov;20(9):1705-13. doi: 10.1007/s10552-009-9422-z. Epub 2009 Aug 25. PMID: 19705288.
[17] Cremer ML, Conlisk E, Felix JC. HPV screening for cervical cancer in rural India. N Engl J Med. 2009 Jul 16;361(3):305; author reply 306. PMID: 19610157.
[18]https://www.uptodate.cn/contents/zh-Hans/cervical-cancer-screening-tests-techniques-for-cervical-cytology-and-human-papillomavirus-testing?search=HPV%E7%AD%9B%E6%9F%A5&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4#H853915922
[19]https://www.uptodate.cn/contents/zh-Hans/screening-for-cervical-cancer-in-resource-limited-settings?sectionName=HPV%E6%A3%80%E6%B5%8B&search=HPV%E7%AD%9B%E6%9F%A5&topicRef=7575&anchor=H12&source=see_link#H12
[20] Mei Zhang, Yijing Zhong, Zhenping Zhao, Zhengjing Huang, Xiao Zhang, Chun Li, Maigeng Zhou, Jing Wu, Limin Wang, Xiaoying Zheng, Linhong Wang. Cervical Cancer Screening Rates Among Chinese Women — China, 2015[J]. China CDC Weekly, 2020, 2(26): 481-486. doi: 10.46234/ccdcw2020.128
Content production