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04.08.2016 | Triage | Leitthema

Epidemiologie, Prävention und Früherkennung des Zervixkarzinoms

verfasst von: PD Dr. med. Nicolas Wentzensen

Erschienen in: Die Onkologie | Ausgabe 10/2016

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Zusammenfassung

Hintergrund

Persistierende Infektionen mit humanen Papillomaviren (HPV) sind die notwendige Ursache des Zervixkarzinoms. Die Entwicklung von HPV-basierten Präventionsverfahren, der HPV-Impfung und der HPV-Testung, führt derzeit zu umfangreichen Veränderungen von Zervixkarzinom-Vorsorgeprogrammen. Eine Dekade nach Einführung der HPV-Imfpung in vielen Ländern werden bereits Reduktionen von HPV-Infektionen und Krebsvorstufen bei jungen Frauen beobachtet. Der Fokus liegt jetzt auf der Integration von neuen Testverfahren im Screening von Populationen mit zunehmenden Impfraten.

Ergebnisse und Schlussfolgerung

Ein erfolgreiches Zervixkarzinom-Vorsorgeprogramm besteht aus verschiedenen Komponenten, vom primären Screening über die Triage zur Kolposkopie mit Biopsie, um Frauen mit Kresbvorstufen zu identifizieren, die eine therapeutische Intervention benötigen. Im primären Screening wird eine kleine Gruppe von Frauen mit erhöhtem Risiko für eine Krebsvorstufe identifiziert, während die große Mehrheit kein erhöhtes Risiko hat. Je nach primärem Testverfahren werden in im Screening positiv-befundeten Frauen zusätzliche Triage-Tests durchgeführt, um zu entscheiden, wer zur Kolposkopie überwiesen werden sollte. Derzeit gibt es drei verschiedene Ansätze für das primäre Zervixkarzinomscreening: die Zervix-Zytologie, die HPV-Testung, und die HPV-Zytologie-Kotestung. Zahlreiche Triage-Tests für HPV-positive Frauen werden derzeit untersucht, darunter die Zytologie, HPV-Genotypisierung, p16/Ki-67 Zytologie und diverse Methylierungstests. Die steigende Anzahl an Optionen für die Früherkennung des Zervixkarzinoms stellt eine Herausforderung für klinische Leitlinien dar. Die zunehmende Komplexität von Vorsorgeprogrammen kann zur Verunsicherung von Ärzten und von am Screening teilnehmenden Frauen führen. Die Präzisionsprävention des Zervixkarzinoms ist eine neuer Ansatz, der umfangreiche Risikodaten, basierend auf der individuellen Vorgeschichte und von Testergebnissen, integriert und einheitliche, risikobasierte Managementempfehlungen gibt.
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Metadaten
Titel
Epidemiologie, Prävention und Früherkennung des Zervixkarzinoms
verfasst von
PD Dr. med. Nicolas Wentzensen
Publikationsdatum
04.08.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Onkologie / Ausgabe 10/2016
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-016-0092-7

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