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자궁경부암과 인유두종바이러스 백신

Cervical Cancer and Human Papillomavirus Vaccines

곽정임|김선영|송윤미
대한가정의학회 (The Korean Academy Of Family Medicine)|2008.11|Korean Journal of Family Medicine|제29권 제11호|pp. 821-830

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자궁경부암uterine cervical neoplasmshuman papillomavirus 16human papillomavirus 18cancer vaccines
주제분류가정의학

초록

자궁경부암은 자궁경부 세포진 검사가 도입된 이래 그 발생이 크게 줄어들었으나 아직도 전 세계적으로 여성 암 중 두 번째로 흔히 발생하는 암이다.1) 한국 중앙암등록자료에 의하면 자궁경부암은 1999~2002년 사이 한국 여성 암 발생의 9.5%를 차지하는 네 번째로 흔한 암이었다.2) 또한 발생률에 비한 사망률이 낮은 편이지만 최근인 2007년에도 한국 여성의 자궁경부암 사망률은 10만명 당 4.4명으로 여성 암 사망의 7위이었으며 총 1,005명의 여성이 자궁경부암으로 사망하였다.3) 자궁경부암 발생위험은 성 행태와의 연관성이 높아서 성관계를 시작한 나이가 어리거나 다수의 성상대자를 둔 경우 증가하며, 출산 횟수 증가, 면역저하, 흡연에 의해서도 위험이 증가한다고 알려져 왔다.4) 하지만 인유두종 바이러스(human papilloma virus, HPV) 감염에 대한 연구가 수행되면서 HPV 감염은 자궁경부암의 가장 중요한 위험요인이며 자궁경부암 발생의 필요조건으로 밝혀졌다.4) 생식기 HPV 감염은 대부분의 경우 증상이 없이 저절로 낫지만, 감염이 반복되거나 지속되면 여성과 남성 모두에게 항문생식기 암과 생식기 사마귀를 일으킬 수 있고, 여성에서 자궁경부암을 유발한다.5) 따라서 지속적인 HPV 감염을 예방할 수 있는 방법이 개발된다면 자궁경부암 질병 부담을 더욱 줄일 수 있을 것으로 기대되어 왔고, 이러한 기대에 부응하여 현재까지 두 종류의 HPV 백신이 개발되어 시판이 승인되었다.6) 이 글에서는 자궁경부암 발생과 관련된 HPV 특성과 HPV vaccine의 효능 및 사용권고사항을 정리하였다.

Abstract

The necessary role of genital infection by specific types of human papillomavirus (HPV) in cervical cancer development provides an opportunity to reduce the risk of cervical cancer, a second leading cancer in women, through prophylactic vaccination. Two types of vaccines targeting HPV 16 and 18 which are responsible for about 70% of all cervical cancer worldwide have been developed: a quadrivalent vaccine (GardasilⓇ) and a bivalent vaccine (CervarixⓇ). Gardasil also targets HPV 6 and 11 causing 90% of genital wart. Both two vaccines contain virus-like particles composed of L1 protein of viral capsid and do not exert infectivity. HPV vaccines were highly effective in preventing persistent infection by vaccine specific type HPV in young women who have not been previously exposed to them. Randomized double- blind placebo-controlled clinical trials have provided evidence that HPV vaccines have high efficacy against cervical precancerous lesion in young women irrespective of baseline HPV infection status. However, HPV vaccines neither treat existing HPV infections nor provide protection against all types of HPV related with cervical cancer. Therefore, even vaccinated females should take cervical cancer screening as recommended. Gardasil has been tested mainly in 9∼26 years old females and Cervarix in 15∼25 years old. Current recommendation for vaccination age is 9∼26 years for Gardasil and 10∼25 years for Cervarix, considering sexual debut and previous clinical trials. There are plenty of remaining issues regarding HPV vaccination such as vaccine efficacy in older women and in males, cost-effectiveness, duration of protection, cross-protection, potential replacement infection, and vaccine compatibility.

참고문헌 (44)

  1. Parkin DM, "Cancer burden in the year 2000. The global picture", Eur J Cancer, 37(8), pp.4~66 (2001)
  2. 2002 Annual report of the Korea central cancer Registry, "Ministry of Health and Welfare", ~ (2003)
  3. Annual report on the cause of death statistics, "Korea National Statistical Office", ~ (2007)
  4. Schiffman MH, "Cervical cancer. In: Cancer epidemiology and prevention", pp.1044~1067 (2006), Oxford university press
  5. Schiffman M, "Chapter 2: natural history of anogenital human papillomavirus infection and neoplasia", J Natl Cancer Inst Monogr, 31, pp.14~19 (2003)
  6. Schmiedeskamp MR, "Human papillomavirus vaccines", Ann Pharmacother, 40(7), pp.1344~1352 (2006)
  7. Bonnez W, "Papillomaviruses. In: Principles and practice of infectious disease", pp.1841~1855 (2005), Elsevior Inc
  8. Duensing S, "Mechanisms of genomic instability in human cancer: insights from studies with human papillomavirus oncoproteins", Int J Cancer, 109(2), pp.157~162 (2004)
  9. Markowitz LE, "Quadrivalent human papillomavirus vaccine: recommendations of the advisory committee on immunization practices (ACIP)", MMWR Recomm Rep, 56(RR-2), pp.1~24 (2007)
  10. Muñoz N, "Epidemiologic classification of human papillomavirus types associated with cervical cancer", N Engl J Med, 348(6), pp.518~527 (2003)
  11. Greer CE, "Human papillomavirus (HPV) type distribution and serological response to HPV type 6 virus-like particles in patients with genital warts", J Clin Microbiol, 33(8), pp.2058~2063 (1995)
  12. Clifford GM, "Human papillomavirus genotype distribution in low-grade cervical lesions: comparison by geographic region and with cervical cancer", Cancer Epidemiol Biomarkers Prev, 14(5), pp.1157~1164 (2005)
  13. Shin HR, "Prevalence of human papillomavirus infection in women in Busan, South Korea", Int J Cancer, 103(3), pp.413~421 (2003)
  14. Cho NH, "Genotyping of 22 human papillomavirus types by DNA chip in Korean women: comparison with cytologic diagnosis", Am J Obstet Gynecol, 188(1), pp.56~62 (2003)
  15. Park TC, "Human papillomavirus genotyping by the DNA chip in the cervical neoplasia", DNA Cell Biol, 23(2), pp.119~125 (2004)
  16. Ho GY, "Natural history of cervicovaginal papillomavirus infection in young women", N Engl J Med, 338(7), pp.423~428 (1998)
  17. Winer RL, "Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students", Am J Epidemiol, 157(3), pp.218~226 (2003)
  18. Burk RD, "Sexual behavior and partner characteristics are the predominant risk factors for genital human papillomavirus infection in young women", J Infect Dis, 174(4), pp.679~689 (1996)
  19. "Common Questions about HPV and Cervical Cancer"[URL]
  20. Winer RL, "Condom use and the risk of genital human papillomavirus infection in young women", N Engl J Med, 354(25), pp.2645~2654 (2006)
  21. ACOG Commitee on Practice Bulletins, "ACOG Practice Bulletin: clinical management guidelines for obstetrician- gynecologists. Number 45, August 2003. Cervical cytology screening", Obstet Gynecol, 102(2), pp.417~427 (2003)
  22. Saslow D, "American Cancer Society Guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors", CA Cancer J Clin, 57(1), pp.7~28 (2007)
  23. "Screening for cervical cancer: recommendations and rationale", Am Fam Physician, 67(8), pp.1759~1766 (2003)
  24. "GlaxoSmithKline Biologicals. Cervarix product information"[URL]
  25. Ault KA, "Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trials", Lancet, 369(9576), pp.1861~1868 (2007)
  26. Harper DM, "Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial", Lancet, 367(9518), pp.1247~1255 (2006)
  27. Paavonen J, "Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial", Lancet, 369(9580), pp.2161~2170 (2007)
  28. Villa LL, "Immunologic responses following administration of a vaccine targeting human papillomavirus types 6, 11, 16, and 18", Vaccine, 4(27), pp.5571~5583 (2006)
  29. Block SL, "Comparison of the immunogenicity and reactogenicity of a prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in male and female adolescents and young adult women", Pediatrics, 118(5), pp.2135~2145 (2006)
  30. Kang S, "Safety and immunogenicity of a vaccine targeting human papillomavirus types 6, 11, 16 and 18: a randomized, placebo-controlled trial in 176 Korean subjects", Int J Gynecol Cancer, 18(5), pp.1013~1019 (2007)
  31. Villa LL, "High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6", 11, 18 L1 virus-like particle vaccine through 5 years of follow-up, pp.Br J Cancer, 2006[DOI]
  32. Villa LL, "Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial", Lancet Oncol, 6(5), pp.271~278 (2005)
  33. Sanders GD, "Cost-effectiveness of a potential vaccine for human papillomavirus", Emerg Infect Dis, 9(1), pp.37~48 (2003)
  34. Taira AV, "Evaluating human papillomavirus vaccination programs", Emerg Infect Dis, 10(11), pp.1915~1923 (2004)
  35. Elbasha EH, "Model for assessing human papillomavirus vaccination strategies", Emerg Infect Dis, 13(1), pp.28~41 (2007)
  36. Goldie SJ, "Projected clinical benefits and cost- effectiveness of a human papillomavirus 16", 18 vaccine, 2004, pp.96(8), 604~615
  37. "Preparing for the introduction of HPV vaccines: policy and programme guidance for countries"[URL]
  38. Kim KH, "Human papillomavirus vaccine", Korean J Pediatr, 50, pp.810~818 (2007)
  39. 김병기, "대한부인종양ㆍ콜포스코피학회의 4가 인유두종 바이러스 백신 접종 권고안", Journal of Gynecologic Oncology, 18(4), pp.259~283 (2007), 대한부인종양콜포스코피학회
  40. "인유두종 바이러스 백신", 서바릭스 프리필드시린지[URL]
  41. Hildesheim A, "Effect of human papillomavirus 16", 18 L1 viruslike particle vaccine among young women with preexisting infection: a randomized trial, 2007, pp.298(7), 743~753
  42. Paavonen J, "Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccineagainst infection with human papillomavirus types 16 and 18 in young women: aninterim analysis of a phase III double-blind, randomised controlled trial", Lancet, 369(9580), pp.2161~2170 (2007)
  43. American Academy of pediatrics Committee on Infectious Diseases, "Recommended immunization schedules for children and adolescents-United States, 2007", Pediatrics, 119(1), pp.207~208 (2007)
  44. "인유두종바이러스 4가 (6, 11, 16, 18형) 백신(유전자 재조합)", 가다실Ⓡ주[URL]

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