phОбщественное здоровьеPublic Health2782-16762949-1274ФГБУ «ЦНИИОИЗ» Минздрава России10.21045/2782-1676-2022-2-4-15-23ph-68Research ArticleМЕДИЦИНСКАЯ ПРОФИЛАКТИКАMEDICAL PREVENTIONНаучное обоснование эффективности первиной и вторичной (скрининга) профилактики рака шейки маткиScientific evidence for the effectiveness of primary and secondary (screening) prevention of cervical cancerhttps://orcid.org/0000-0002-2824-3704ЗаридзеД. Г.ZaridzeD. G.

д-р мед. наук, профессор, член-корреспондент РАН, руководитель отдела клинической эпидемиологии

D.Sc (Medicine), Professor, Corresponding Member of RAS, Head of the Department of Clinical Epidemiology, Research Institute of Clinical Oncology

dgzaridze@crc.umos.ruСтилидиИ. С.StilidiI. S.

д-р мед. наук, профессор, академик РАН, директор

D.Sc (Medicine), Professor, Academician of RAS, Director

https://orcid.org/0000-0002-6847-9295МукерияА. Ф.MukeriaA. F.

д-р мед. наук, ведущий научный сотрудник отдела клинической эпидемиологии

D.Sc (Medicine), Senior scientist, , Department of Clinical Epidemiology, Research Institute of Clinical Oncology

amukeria@mail.ruФГБУ НМИЦ онкологии им. Н.Н. Блохина Минздрава РоссииРоссияN.N. Blokhin National Medical Research Center of OncologyRussian Federation202226112022241523Copyright © Заридзе Д.Г., Стилиди И.С., Мукерия А.Ф., 20222022Заридзе Д.Г., Стилиди И.С., Мукерия А.Ф.Zaridze D.G., Stilidi I.S., Mukeria A.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ph.elpub.ru/jour/article/view/68

Получены неопровержимые научные данные эффективности вакцинации против вируса папилломы человека (ВПЧ). В рандомизированных клинических исследованиях показано, что все три вакцины: двухвалентная (CERVARIX), четырехвалентная (GARDASIL) и девятивалентная (GARDASIL9) предотвращают распространение инфекции и развитие цервикальных интраэпителиальных неоплазий (ЦИН 1–3), рака in situ и инвазивного рака шейки матки (РШМ). Результаты клинических исследований получили подтверждение на практике, в реальной жизни, в странах, где вакцинацию против ВПЧ включили в национальный календарь иммунизации более 15 лет назад и в 2006–2008 годах начали прививать 12–13 летних девочек, а через несколько лет и мальчиков. Долгосрочные наблюдения за когортами женщин показали, что ВПЧ-вакцинация безопасна. В 2020 году Генеральный директор ВОЗ объявил о начале реализации эпохальной инициативы и официально представил стратегию по элиминации РШМ как проблемы общественного здоровья. Документ включает промежуточные цели на 2030 г.: вакцинация 90% девочек до достижения 15-летнего возраста, скрининг, основанный на ВПЧ ДНК-тестировании 70% женщин в возрасте 35 и 45 лет, адекватное лечение 90% женщин с патологией шейки матки, выявленной при скрининге, лечение 90% женщин с диагнозом предрака и рака шейки матки. Под элиминацией РШМ ВОЗ подразумевает снижение заболеваемости до 4 случаев на 100 000 женщин, т. е. до уровня редкой болезни. Эта цель будет достигнута странами, которые начали вакцинацию девочек 15 лет назад, в 2006–08 годах. В России заболеваемость РШМ растет и прогнозируется дальнейший ее рост. Стандартизованный по мировому стандартному населению показатель на 100000 женского населения вырос с 10,2 в 1993 году до 16,1 в 2018 г. В 2030 году он достигнет 20 на 100 000 женского населения.Вакцинация против ВПЧ и скрининг изменят направление тренда от роста к снижению и сохранят несколько сотен тысяч жизней.

The evidence of HPV vaccination effectiveness is overwhelming. The randomized clinical trials showed that all three vaccines currently in use, bivalent (CERVARIX), quadrivalent (GARDASIL) and nanvalent (GARDASIL9) effectively prevent HPV infection, cervical intraepithelial neoplasia (CIN) 1–3 and invasive cervical cancer. The results of clinical trials have been confirmed by real life evidence – population data from countries were vaccination of 12–13 girls started in 2006–08. HPV vaccination is safe. This is proven by long term follow up of the cohorts of vaccinated women. In 2020 the WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. The document includes the interim targets for 2030: vaccination of 90% of girls by 15 years; HPV testing based screening at age 35 and 45 of 70% of women; treatment of 90% of women with screening detected cervical pathology; treatment of 90% of women with precancerous lesions and cancer of the cervix. Under elimination of cervical cancer WHO means the decrease in its incidence down to 4 cases per 100 000 population. This goal will be achieved by 2030 in countries that started HPV vaccination 15 years ago in 2006–2007.In Russia incidence of cervical cancer is on increase since 1993 from 10, 2 to 16, 1 in 2018. It is predicted that the increase will continue and in 2030 the age standardized incidence rate will reach 20 per 100 000 women. HPV vaccination and HPV test based screening will change the direction of the trend from increase to decrease and save several hundreds of lives

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The authors declare that there are no conflicts of interest present.