자궁경부암과 인유두종바이러스 백신 = Cervical Cancer and Human Papillomavirus Vaccines

다국어 초록 (Multilingual 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.

국문 초록 (Abstract)

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.

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