子宮頸癌的疫苗在全球已經上市十多年，理論上可以預防子宮頸癌 ，但還未有大型研究結果 。前幾天在新英格蘭醫學雜誌上發表了一份在瑞典160萬名年輕女性接種4價HPV 疫苗12年的追蹤研究報告。下方的圖表裡，很清楚的表示了有無接種疫苗與各年齡層子宮頸癌的發生頻率。
17歲以前接種疫苗的女性在12年的追蹤過程中發生子宮頸癌的機率，在調整可能偏見的變因過後，大約是不到未接種疫苗女性機率的3-4成，這相當於之前預測的結果，身爲婦產科醫師的我對這個結果其實並不感到驚訝，因為四價疫苗涵蓋的病毒株大約佔所有子宮頸癌病毒株的6-7成。
這個疫苗的發展從找到HPV 病毒為主要致癌機轉（99.7%)，到發展出全球疫苗造福所有女性，是醫學研究的一大勝利。這張圖表勝過千言萬語，值得與大家分享。
註）
4 價疫苗比2價多兩型可以多預防病毒疣。
9 價疫苗除了以上還包括一些在亞洲與台灣流行的其他致癌株 可以達到近9成涵蓋率。
圖中子宮頸癌好發的年齡開始在23歲其實是因爲瑞典在這個年齡開始健保抹片檢查但以直線回推確實22歲之前子宮頸癌發生率非常小。
在這份研究裡，50萬位接種疫苗的女性裡仍有19位女性在追蹤過程不幸得到子宮頸癌，所以疫苗不是100%的預防。
目前我國疫苗接種情況良好，國一即可施打2價的公費疫苗，但仍建議30歲以上女性或有性行為三年以上年輕女性，定期做子宮頸抹片檢查。
#HPV疫苗真的有效
＃6分鐘仍會護一生
The human papilloma virus (HPV) vaccine for prevention of cervical cancer has been around for more than a decade. The result of a 12-year follow-up study on a 1.6 million Swedish cohort was published last week in the New England Journal of Medicine. The graph below speaks more than a thousand words about the importance of HPV vaccination for women.
The cumulative incidence of cervical cancer in women who received vaccination before the age of 17 is approximately half of those who never received vaccination. After adjustment of covariate, the incidence ratio is about 0.37. This result does not surprise me because the HPV vaccine covers serotype 16 and 18 which cause up to 70% of all cervical cancer.
We have come a long way since the discovery of the association between HPV and cervical cancer as early as the 60's to the invention of HPV vaccine in the early 2000's. This fabulous result of cancer reduction from a vaccination program in a large scale population is an example of medical innovation and collaboration. I would not be surprised if another Nobel Laureate is crowned on a scientist working in this area in the near future (such as the distinguished Australian, Professor Ian Frazer. )
p.s.
the quadrivalent vaccine is better than the double-valent because it also covers some serotypes that cause genital warts.
the 9-valent vaccine also includes carcinogenic serotypes that are common in Asia.
the incidence of cervical cancer begins to rise at age of 23, this reflects the starting age of pap smear program in Sweden. However, the incidence of cervical cancer before age of 23 is ver low.
there are still 19 women who developed cervical cancer out of the half-million women who received HPV vaccination, so vaccination does not offer 100% protection
There is a high rate of vaccination uptake in Taiwan. However, it is still important to do pap smear regularly for women over 30 or those who are sexually active for more than 3 years.
