Breast

1
???????????

• ???????????
• ?? ????

2

• ???????????????,?????????????

3
(No Transcript)
4
???

• ??50000?????, 80??????
• ??
• ????200000????????
• ??????????,??????,?
• ?????????
• ??????,??????????13.8
• ?,???? 5????????
• ????????????

5
??????
Less developed countries
More developed countries

Breast
Cervix
Ovary
Endometrium
Colon/rectum
Lung
Stomach
600
200
400
600
0
400
200
Annual number of cases (thousands)
Adapted from Parkin et al, Eur J Cancer 37S4,
2001
6

• HPV?????????????,99????HPV??,??HPV16 ?HPV18
  (??70)
• 1Bosch FX, et al. J Natl Cancer Inst 1995
  87796-802
• 2Matsukura M, et al. Int J Cancer 1995
  6113-22

7
HPV?????
8
HPV???

• 1907??????????????
• Richard Shope ?????????????????
• 70???????????
• ??1977??????Hausen?????HPV??????,HPV????????????

9
???HPV?

• HPV????????,??DNA??DNA??
• ??,??52-55nm
• ????????????????????

10
???HPV
11
??HPV

• ??????????????????????????,??DNA?????????????
• ??DNA?????????????,?????
• HPV????????????????????????????
• ????????????????HPV???????
• HPV?????,???????

12
??HPV??

• 10-30?????HPV(Human Papillomvirus),?????????(50
  -80)
• ????20-29?(40)
• ??? 3 ? 8 ?(?? 2.8 ?)

13
HPV????

• 1-2?????????
• ????????,????????????(SPI), ?????????
• ??1-2??????,70?????????????????

14
????

• ???????????DNA,???????????????
• ?????????????,??????,????????????????????????
  ?,??????,?????????????,?????E6,E7??????????
• ???????,??????????????????

15
HPV??

• ??????????????????????
• ??????????,???????????
• ???HPV?????????????

16

• ???HPV???????,??HPV?????,????HPV????????

17
?????467????????? HPV?PCR???? ???HPV???46
5??60???????HPV?? 70????????HPV????

• ,

SOURCE GRAPH ADAPTED FROM R. L. WINER ET AL.,
AMERICAN JOURNAL OF EPIDEMIOLOGY 157, 218 (2003)
18
HPV??

• ?????HPV?138???,???????
• ???40??
• ?????????????
• ???HPV(?????,LRHPV)
• ???HPV(????,HRHPV)

19
???HPV(LRHPV)

• ???HPV??HPV6?11?42?43?
• ??????????????????HPV??,???????HPV-6,HPV-11( 90
  )
• ??LRHPV,??????????????CIN -I ( CIN Cervical
  Intraepithelial Neoplasia )?????????????(CIN-
  II)
• LRHPV HPV DNA?????????,??????????,??LRHPV?????????
  ?????(CIN -III)??????

20
???HPV(HRHPV)

• ???HPV(HRHPV)??HPV16?18?31?33?35?39?45?51?52?56?5
  8?59????HPV66?70?53?67?83,AE5?????????
• ?????HPV16?HPV18
• HRHPV?CIN III??????,?????????
• ??,?80???????4???(16? 18?31??
• 45?)?HPV ?????
• HPV DNA??????,???????,?
• ????

21
???

• ?????????,????????,??????????????????,???????
• ???????????????????
• ??1?HPV????????
• ???HPV(HRHPV)??????????????HPV?????

22
???HPV??????

• ??CIN????????????????HPV
  DNA?????DNA?,??HPV DNA???E6?E7??????????,?????????
  ?,?????????,????????????????,???????????????

23
?????????

• ??????
• ????
• ????
• ??
• ????????????????? N-?????,????????DNA?????????D
  NA????,?????????????????,???HPV???????,??CIN??????
  

24
??????

• ????????????(SIL)/????????( CIN)
• ????????????????,???????
• 10-15?????????????????
• ??CIN???????????????

25
?????????(CIN)

• CIN (Cervical Intraepithelial Neoplasia
  )????????????,????????????????????????????,?????
• CIN?????????,???????????????????,???????????,????
  ???????
• ??????CIN?????????,????????CIN??????????,?CIN????
  ????????7??

26
?????????(CIN)

• ??????????????CIN????CIN??CIN??CIN??????????
  ?????,???????????????15?30?45,?CIN?????????????
  ??

27
??????

• ???????????,???????,????????,???????,?????????
  ???????

28
?????????Cervical Dysplasia
29
CIN 1

• ??????????
• ????????????????,????????????,????,?????,??????,?
  ?????,???????????????????????
• ????HPV????

30
CIN 2

• ?????????
• ?????????????????????,????,?????,???,??????,??????
  ??,???????????????????????
• ????HPV????

31
CIN 3

• ???????????????
• ????????????
• ??,??????????????
• ???????
• ????HPV????

32
?????
33
?????
34
?????(SIL) ?????????( CIN)
35

• ????????????????????????????????(CCT)?????
  ??????(TCT)?????????????????????,?????????,?PCR???
  ?

36
???????(PAP)

• ?????????(????)????????????????

37
???????(PAP)

• ???????HPV?????????????
• ???30-89
• ????PAP??????????????76.6
• 50??????????????PAP??
• errero R. Monogr Natl Cancer Inst 1996 211-6

38
PAP??

• ????????
• 21???????????PAP??
• 20-64??3???(UK)
• 21-70??2-3???(US)
• ?????,6?????,???3????
• ??6??????3?????,?????
• ?????, ??????????????
• ??????????

39
???????HPV??????
40
??????????
41
??????????
42
???????
43
?????????(TCT)

• ????????????(Thinprep cytologic test, TCT)
  ??????????????????????????????????????????????????
  ???????????????????????????,??????????????,???????
  ???????????,??????????????????????

44
?????TCT?????????????????

• ??????????????,
  
• 
  TCT??????????????
• ?????????
• 
  ?????????????
• 
  ????????,?????
• 
  ????????????
• 
  ??????????

45
???????

• ?????????????????????,???HPV???????,?????95.
  26?

46
?????????HPV???????
47
??HPV??
48
??????????????????

• ???????????????1040?,???????????????????,??
  ????????????????,???????????,???????????????,?????
  ???????????????,????????????????????????

49
(No Transcript)
50
??????????????????

• Reid???????(reid colposcopic
  index,RCI),??????? ?????,?????????????4?,????02??
  ??,?????CIN?????,??????????,?????????,????????????
  ?

51
??????????????????

• ??????????????????????
• ???,???????????CIN??????,????????????????????
  ??(SPI)?????????
• ??????,????????????????????????
• 2001????????????(ASCCP)???????CIN?????96,????48
  69?CIN??????????????????????

52
??????

• CIN1???????????????????????,?????
• CIN2????????????????,??????????
• CIN3??????????????,?????????????

53
????
54
????CIN
55

• ???????,????????????????,??????????????????
  ,???????????????????

56

• ??CIN????????????
• ?????????????,????????????????

57
???????

• ?????????PCR????????? ???
• ???????????????????DNA? ??
• ???PCR???????(HC-?)??????????HPV-DNA???,?????
  HPV????????HPV-DNA???????????????,??????????????

58
??

• ???????HPV?????????,????HPV???????,?????
  HPV????,???????HPV???????,????????????????????

59

• ?HPV???????,?????????????(??????)??????(?????)
  ?????????

60
CIN???

• ???????????
• CIN-???????,??????(??????)
• CIN-??CIN-? ????????????????????,??LEEP???????
  ?????

61

• ??,??????????????????????HPV??,?????????????
  ????HPV????????????,???????????????????

62
HPV??

• ?????????????
• ???????HPV?????????? ???(??????)?
• ?? HPV????????????????????????,???HPV??????L1?
  ??????L2??????????????????????????????????,???DNA,
  ??????????????????????,????????HPV??????

63

• ???????????????????????(VLP) ?????????????????????
  ???????????
• ?????????????????HPV????,?????????????E6?E7??????
  ???????HPV16?18?????????????,HPV16?18?E6?E7??????,
  ?????????????????????????????,??????????HPV???????
  ?,??????????????????
• ?????HPV16?18??E6?E7?????????????????

64

• 2006?6?8?,??FDA???????HPV 6?11?16?18???????(G
  ardasil)?????4?HPV??????????????????????

65

• Gardasil??????????????,???????????????,???VLP??,??
  ???VLP???????????
• ???6??11??16??18??HPV???????100,
  ???????90??????70?????????HPV??????70?????

66

• ??????????9? 26???????????????????HPV?????????????
  ?????????????,??????????????????????
• ???????360-500??,????,????????????

67

• 2007?9?24?,???????????????HPV 6?11?????(Cervarix)?
  ??

68

• ???????????????????????????2006????????

69
HPV?HIV???????2008???????
?????????????(Harald zur Hausen)(??),???1936?,3
6???????????????????,???????????(HPV)????????????
???????????????????????(International Journal of
Cancer)????
70

• ???HPV???????????????????,???????????????????,????
  ???????HPV????????
• ???????????????,HPV???????????5?,?????????????????
  ???????????????????????????? 

71

• ????????2006?9??HPV????????????????,??????
• ??9-26??????????????
• ???????????,?????????????????????????,????????70?
  ????

72

• ????????????????????????,???????????????,?????????
  ?????????????
• ??????26??????????????????????

73
???

• ??????(HPV)??????????,?????????????????????
  ???????????????????????

74

• ??
• Thank You