Вестник БГУ. Медицина и фармация
Библиографическое описание:
, ЦЕРВИКАЛЬНАЯ ИНТРАЭПИТЕЛИАЛЬНАЯ НЕОПЛАЗИЯ: ЭПИДЕМИОЛОГИЯ, ФАКТОРЫ РИСКА И СОВРЕМЕННЫЕ ПОДХОДЫ К ПРОФИЛАКТИКЕ И СКРИНИНГУ (ОБЗОР ЛИТЕРАТУРЫ) // Вестник БГУ. Медицина и фармация. - 2026. №1. . - С. 3-14.
Заглавие:
ЦЕРВИКАЛЬНАЯ ИНТРАЭПИТЕЛИАЛЬНАЯ НЕОПЛАЗИЯ: ЭПИДЕМИОЛОГИЯ, ФАКТОРЫ РИСКА И СОВРЕМЕННЫЕ ПОДХОДЫ К ПРОФИЛАКТИКЕ И СКРИНИНГУ (ОБЗОР ЛИТЕРАТУРЫ)
Финансирование:
Коды:
Аннотация:
Цервикальная интраэпителиальная неоплазия (ЦИН) является предраковым поражением шейки матки и ключевым звеном канцерогенеза, ассоциированного с виру- сом папилломы человека (ВПЧ) высокого онкогенного риска. Несмотря на доказанную эффективность вакцинации против ВПЧ и организованных программ скрининга, заболе- ваемость и смертность от рака шейки матки сохраняют высокую медико-социальную значимость во многих странах, включая регионы с ограниченным охватом профилакти- ческими мероприятиями. В обзоре обобщены современные представления об эпидемио- логии ЦИН и рака шейки матки, обсуждены ведущие факторы риска и кофакторы про- грессирования ВПЧ-инфекции, включая особенности сексуального поведения, курение, иммунодефицитные состояния, сопутствующие инфекции и репродуктивные факторы. Отдельное внимание уделено современным подходам к вторичной профилактике: переход к первичному ВПЧ-тестированию, возможности самозабора для повышения охвата, а также актуальные данные о популяционном эффекте вакцинации и глобальной стратегии ВОЗ по элиминации рака шейки матки. Комплексная реализация первичной и вторичной профилактики, адаптированная к региональным условиям, рассматривается как основа снижения бремени ВПЧ-ассоциированных заболеваний.
Ключевые слова:
цервикальная интраэпителиальная неоплазия (ЦИН), LSIL (low- grade squamous intraepithelial lesion), HSIL (high-grade squamous intraepithelial lesion), ви- рус папилломы человека (ВПЧ), факторы риска, скрининг, ВПЧ-тестирование, вакцина- ция, профилактика.
Список литературы:
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Li L., Li L. Y., Zhu L. P., Xun X. L., Qi X. L. Screening for cervical cancer, breast cancer, and reproductive tract infection in a rural area, Jiangxi Province. China Cancer. 2010; 19(5): 797–800.
Wang T., Wu M. H., Wu Y. M., Zhang W. Y. A Population-based study of invasive cervical cancer patients in Beijing: 1993–2008. Chinese Medical Journal (English). 2015; 128(24): 3298–3304.
Tao L., Han L., Li X. et al. Prevalence and risk factors for cervical neoplasia: a cervical cancer screening program in Beijing. BMC Public Health. 2014; 14(1): 1185.
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Solomon D., Davey D., Kurman R. et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002; 287(16): 2114– 2119.
Fu G. Y., Yang H. Y., Liu Z. L., Wang Z. Y., Jiang P., Wang Z. Study on a multi-test diagnostic kit to diagnose vaginitis. Journal of Pathogen Biology. 2012; 6(6): 433–435.
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Yang Y. X., Yang G. Y., Pan C. China Food Composition Tables 2002. Beijing, Beijing University Medical Press, 2002, p. 79.
Eversole G. M., Moriarty A. T., Schwartz M. R. et al. Practices of participants in the College of American Pathologists Interlaboratory Comparison Program in cervicovaginal cytology, 2006. Archive of Pathologists Lab Medical. 2010; 134(9): 331–335.
López-Alegría F., Poblete O. Q., Lorenzi D. S., Oyanedel J. C. Clinical management of the first ASC-US report in Chile. Prospective single-cohort study. Sao Paulo Medical Journal. 2015; 133(5): 480–487.
24 Zheng B., Austin R. M., Liang X. et al. Bethesda System reporting rates for conventional Papanicolaou tests and liquid-based cytology in a large Chinese, College of American Pathologists-verified independent medical laboratory: analysis of 1,394,389 Papanicolaou test reports. Archive of Pathologists Laboratory Medicine. 2015; 139(3): 373–377.
Tao X., Austin R. M., Zhang H. et al. Pap test reporting rates for conventional smear and liquid-based cervical cytology from the Largest Academic Women’s Hospital in China: Analysis of 1,248,785 pap test reports. Acta Cytologica. 2015; 59(6): 445–451.
Zheng B., Li Z., Liang X. et al. Cervical cytology reporting rates from China’s Largest College of American Pathologists-Certified Laboratory with a focus on
squamous cell carcinoma cytology and its histopathological follow-up results. Acta Cytologica. 2015; 59; 5: 399–404.
Zhao F. H., Zhu F. C., Chen W. et al. Baseline prevalence and type distribution of human papillomavirus in healthy Chinese women aged 18–25 years enrolled in a clinical trial. International Journal of Cancer. 2014; 135(11): 2604–2611.
Ma L., Gu X. F., Ma J. F. et al. Analysis on the prevalence rate of cervical cancer and screening willingness of rural women from the areas with high prevalence of cervical cancer. Maternal and Child Health Care of China. 2012; 27(38): 5974– 5977.
Zhang Q., Cao D., Ma Q. et al. Natural outcome of genital tract high-risk human papillomavirus infection and associated factors among 760 women. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2015; 37(5): 534–540.
Li C. D., Wu M. H., Wang J. D. et al. A population-based study on the risks of cervical lesion and human papillomavirus infection among women in Beijing, People's Republic of China. Cancer Epidemiology, Biomarkers & Prevention. 2010; 19(10): 2655–2664.
Roura E., Castellsague X., Pawlita M. et al. Smoking as a major risk factor for cervical cancer and pre-cancer: results from the EPIC cohort. International Journal of Cancer. 2014; 135(18): 453–466.
Oh H. Y., Kim M. K., Seo S. S., Lee J. K. Association of Combined Tobacco Smoking and Oral Contraceptive Use With Cervical Intraepithelial Neoplasia 2 or 3 in Korean Women. Journal Epidemiology. 2016; 26(7): 22–29.
Chih H. J., Lee A. H., Colville L., Binns C. W., Xu D. A review of dietary prevention of human papillomavirus-related infection of the cervix and cervical intraepithelial neoplasia. Nutrition Cancer. 2013; 65(7): 317–328.
Flatley J. E., McNeir K., Balasubramani L. et al. Folate status and aberrant DNA methylation are associated with HPV infection and cervical pathogenesis. Cancer Epidemiology, Biomarkers & Prevention. 2009; 18(10): 2782–2789.
Piyathilake C. J., Macaluso M., Chambers M. M. et al. Folate and vitamin B12 may play a critical role in lowering the HPV 16 methylation-associated risk of developing higher grades of CIN. Cancer Prevention Research. 2014; 7(11): 1128–1137.
Oh H. Y., Kim M. K., Seo S. et al. Alcohol consumption and persistent infection of high-risk human papillomavirus. Epidemiology Infection. 2015; 143(7): 1442–1450.
Oh H. Y., Kim M. K., Seo S. S., Lee J. K. Association of combined tobacco smoking and oral contraceptive use with cervical intraepithelial neoplasia 2 or 3 in Korean women. Journal Epidemiology. 2016; 26(1): 22–29.
Garland S. M., Kjaer S. R., Munoz N. et al. Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of Real-world Experience. Clinical Infectious Diseases. 2016; 63(4): 519–527.
Peng Y., Wang X., Feng H., Yan G. Is oral contraceptive use associated with an increased risk of cervical cancer? An evidence-based meta-analysis. Journal of Obstetrics and Gynaecology Research. 2017; 43(5): 913–922.
Forman D., de Martel C., Lacey C. J. et al. Global burden of human papillomavirus and related diseases. Vaccine. 2012; 30(5): F12–F23.
Chelimo C., Wouldes T. A., Cameron L. D., Elwood J. M. Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. Journal of Infection. 2013. 66(3): 207–217.
Zhao W., Hao M., Wang Y. et al. Association between the state of folate and cervical intraepithelial neoplasia. European Journal of Clinical Nutrition. 2016; 70(7): 837–842.
Louie K. S., Castellsague X., de Sanjose S. et al. Smoking and passive smoking in cervical cancer risk: pooled analysis of couples from the IARC multicentric case- control studies. Cancer Epidemiology, Biomarkers & Prevention. 2011; 20(7): 1379– 1390.
Natphopsuk S., Settheetham-Ishida W., Sinawat S. et al. Risk factors for cervical cancer in northeastern Thailand: detailed analyses of sexual and smoking behavior. Asian Pacific Journal of Cancer Prevention. 2012; 13(11): 5489–5495.
World Health Organization. Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. Geneva, World Health Organization, 2020. Available at: https://www.who.int/publications/i/item/9789240014107 (accessed 17.12.2025).
World Health Organization. WHO Guideline for Screening and Treatment of Cervical Pre-Cancer Lesions for Cervical Cancer Prevention. 2nd ed. Geneva, World Health Organization, 2021. Available at: https://www.who.int/publications/i/ item/9789240030824 (accessed 17.12.2025).
World Health Organization. Human Papillomavirus Vaccines: WHO position paper, December 2022. Weekly Epidemiological Record. 2022; 97(50): 645–672. Available at: https://www.who.int/publications/journals/weekly-epidemiological- record (accessed 17.12.2025).
Sung H., Ferlay J., Siegel R. L. et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021; 71(3): 209–249.
International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 100B: Biological Agents. Lyon, IARC, 2012. Available at: https://publications.iarc.fr/119 (accessed 17.12.2025).
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Crosbie E. J., Einstein M. H., Franceschi S., Kitchener H. C. Human papillomavirus and cervical cancer. The Lancet. 2013; 382(9895): 889–899.
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Chelimo C., Wouldes T. A., Cameron L. D., Elwood J. M. Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. Journal of Infection. 2013; 66(3): 207–217.
Roura E., Castellsagué X., Pawlita M. et al. Smoking as a major risk factor for cervical cancer and pre-cancer: results from the EPIC cohort. International Journal of Cancer. 2014; 135(2): 453–466.
Louie K. S., Castellsagué X., de Sanjosé S. et al. IARC Multicentric Cervical Cancer Study Group. Smoking and passive smoking in cervical cancer risk: pooled analysis of couples from the IARC multicentric case-control studies. Cancer Epidemiology, Biomarkers & Prevention. 2011; 20(7): 1379–1390.
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International Collaboration of Epidemiological Studies of Cervical Cancer. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. The Lancet. 2007; 370(9599): 1609–1621.
Peng Y., Wang X., Feng H., Yan G. Is oral contraceptive use associated with an increased risk of cervical cancer? An evidence-based meta-analysis. Journal of Obstetrics and Gynaecology Research. 2017; 43(5): 913–922.
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Torre L. A., Bray F., Siegel R. L. et al. Global cancer statistics, 2012. CA: A Cancer Journal for Clinicians. 2015; 65(2): 87–108.
Crosbie E. J., Einstein M. H., Foreschi S. Kitchener H. C. Human Papilloma Virus and Cervical Cancer. 2013. 382(9895): 889–899.
International Agency for Research on Cancer (IARC) monographs on the Evaluation of Carcinogenic Risks to Humans. A Review of Human Carcinogens: Biological Agents, Lyon. 2012; 100B.
International collaboration of epidemiological studies of cervical cancer. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16 573 women with cervical cancer and 35 509 women without cervical cancer from 24 epidemiological studies. The Lancet. 2007; 370(9599): 1609–1621.
Moy L. M., Zhao F. H., Li L. et al. Human papillomavirus testing and cervical cytology in primary screening for cervical cancer among women in rural China: comparison of sensitivity, specificity, and frequency of referral. International Journal of Cancer. 2010; 127(3): 646–656.
Zhao F. H., Lewkowitz A. K., Chen F. et al. Prevalence of human papillomavirus and cervical intraepithelial neoplasia in China: a pooled analysis of 17 population-based studies. International Journal of Cancer. 2012; 131(12): 2929– 2938.
Ting J., Kruzikas D. T., Smith J. S. A global review of age-specific and overall prevalence of cervical lesions. International Journal of Gynecological Cancer. 2010; 20; 7: 1244–1249.
Bray F., Ren J. S., Masuyer E., Ferlay J. Global estimates of cancer prevalence for sites in the adult population in 2008. International Journal of Cancer. 2013; 132(5): 1133–1145.
Di J., Rutherford S., Chu C. Review of the cervical cancer burden and population-based cervical cancer screening in China. Asian Pacific Journal of Cancer Prevention. 2015; 16(17): 7401–7407.
Wang X. Z., Liu K. R., Yuan F. M. et al. Analysis of both high incidence of esophageal and cervical cancer in Yangcheng County, Shanxi Province. China Cancer. 2011; 4(7): 259–261.
Li L., Li L. Y., Zhu L. P., Xun X. L., Qi X. L. Screening for cervical cancer, breast cancer, and reproductive tract infection in a rural area, Jiangxi Province. China Cancer. 2010; 19(5): 797–800.
Wang T., Wu M. H., Wu Y. M., Zhang W. Y. A Population-based study of invasive cervical cancer patients in Beijing: 1993–2008. Chinese Medical Journal (English). 2015; 128(24): 3298–3304.
Tao L., Han L., Li X. et al. Prevalence and risk factors for cervical neoplasia: a cervical cancer screening program in Beijing. BMC Public Health. 2014; 14(1): 1185.
Wang J. T., Ma X. C., Cheng Y. Y. et al. A case-control study on the association between folate and cervical cancer. Zhonghua Liu Xing Bing Xue Za Zhi. 2006; 27(5): 424–427.
Solomon D., Davey D., Kurman R. et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002; 287(16): 2114– 2119.
Fu G. Y., Yang H. Y., Liu Z. L., Wang Z. Y., Jiang P., Wang Z. Study on a multi-test diagnostic kit to diagnose vaginitis. Journal of Pathogen Biology. 2012; 6(6): 433–435.
Nugent R. P., Krohn M. A., Hillier S. L. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. Journal of Clinical Microbiology. 1991; 29(2): 297–301.
Wright T. C., Ronnett B. M., Kurman R. J. Precancerous lesions of the cervix. In: Kurman R. J., Ellenson L. H., Ronnett B. M. (eds). Blaustein’s Pathology of the Female Genital Tract. 6th ed. New York, Springer, 2011, pp. 193–252.
Wang J., Zhao W. Application of simplified food frequency questionnaires on dietary assessment. Chinese Journal of Prevention and Control of Chronic Diseases. 2000; 8(3): 29–31.
Yang Y. X., Yang G. Y., Pan C. China Food Composition Tables 2002. Beijing, Beijing University Medical Press, 2002, p. 79.
Eversole G. M., Moriarty A. T., Schwartz M. R. et al. Practices of participants in the College of American Pathologists Interlaboratory Comparison Program in cervicovaginal cytology, 2006. Archive of Pathologists Lab Medical. 2010; 134(9): 331–335.
López-Alegría F., Poblete O. Q., Lorenzi D. S., Oyanedel J. C. Clinical management of the first ASC-US report in Chile. Prospective single-cohort study. Sao Paulo Medical Journal. 2015; 133(5): 480–487.
24 Zheng B., Austin R. M., Liang X. et al. Bethesda System reporting rates for conventional Papanicolaou tests and liquid-based cytology in a large Chinese, College of American Pathologists-verified independent medical laboratory: analysis of 1,394,389 Papanicolaou test reports. Archive of Pathologists Laboratory Medicine. 2015; 139(3): 373–377.
Tao X., Austin R. M., Zhang H. et al. Pap test reporting rates for conventional smear and liquid-based cervical cytology from the Largest Academic Women’s Hospital in China: Analysis of 1,248,785 pap test reports. Acta Cytologica. 2015; 59(6): 445–451.
Zheng B., Li Z., Liang X. et al. Cervical cytology reporting rates from China’s Largest College of American Pathologists-Certified Laboratory with a focus on
squamous cell carcinoma cytology and its histopathological follow-up results. Acta Cytologica. 2015; 59; 5: 399–404.
Zhao F. H., Zhu F. C., Chen W. et al. Baseline prevalence and type distribution of human papillomavirus in healthy Chinese women aged 18–25 years enrolled in a clinical trial. International Journal of Cancer. 2014; 135(11): 2604–2611.
Ma L., Gu X. F., Ma J. F. et al. Analysis on the prevalence rate of cervical cancer and screening willingness of rural women from the areas with high prevalence of cervical cancer. Maternal and Child Health Care of China. 2012; 27(38): 5974– 5977.
Zhang Q., Cao D., Ma Q. et al. Natural outcome of genital tract high-risk human papillomavirus infection and associated factors among 760 women. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2015; 37(5): 534–540.
Li C. D., Wu M. H., Wang J. D. et al. A population-based study on the risks of cervical lesion and human papillomavirus infection among women in Beijing, People's Republic of China. Cancer Epidemiology, Biomarkers & Prevention. 2010; 19(10): 2655–2664.
Roura E., Castellsague X., Pawlita M. et al. Smoking as a major risk factor for cervical cancer and pre-cancer: results from the EPIC cohort. International Journal of Cancer. 2014; 135(18): 453–466.
Oh H. Y., Kim M. K., Seo S. S., Lee J. K. Association of Combined Tobacco Smoking and Oral Contraceptive Use With Cervical Intraepithelial Neoplasia 2 or 3 in Korean Women. Journal Epidemiology. 2016; 26(7): 22–29.
Chih H. J., Lee A. H., Colville L., Binns C. W., Xu D. A review of dietary prevention of human papillomavirus-related infection of the cervix and cervical intraepithelial neoplasia. Nutrition Cancer. 2013; 65(7): 317–328.
Flatley J. E., McNeir K., Balasubramani L. et al. Folate status and aberrant DNA methylation are associated with HPV infection and cervical pathogenesis. Cancer Epidemiology, Biomarkers & Prevention. 2009; 18(10): 2782–2789.
Piyathilake C. J., Macaluso M., Chambers M. M. et al. Folate and vitamin B12 may play a critical role in lowering the HPV 16 methylation-associated risk of developing higher grades of CIN. Cancer Prevention Research. 2014; 7(11): 1128–1137.
Oh H. Y., Kim M. K., Seo S. et al. Alcohol consumption and persistent infection of high-risk human papillomavirus. Epidemiology Infection. 2015; 143(7): 1442–1450.
Oh H. Y., Kim M. K., Seo S. S., Lee J. K. Association of combined tobacco smoking and oral contraceptive use with cervical intraepithelial neoplasia 2 or 3 in Korean women. Journal Epidemiology. 2016; 26(1): 22–29.
Garland S. M., Kjaer S. R., Munoz N. et al. Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of Real-world Experience. Clinical Infectious Diseases. 2016; 63(4): 519–527.
Peng Y., Wang X., Feng H., Yan G. Is oral contraceptive use associated with an increased risk of cervical cancer? An evidence-based meta-analysis. Journal of Obstetrics and Gynaecology Research. 2017; 43(5): 913–922.
Forman D., de Martel C., Lacey C. J. et al. Global burden of human papillomavirus and related diseases. Vaccine. 2012; 30(5): F12–F23.
Chelimo C., Wouldes T. A., Cameron L. D., Elwood J. M. Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. Journal of Infection. 2013. 66(3): 207–217.
Zhao W., Hao M., Wang Y. et al. Association between the state of folate and cervical intraepithelial neoplasia. European Journal of Clinical Nutrition. 2016; 70(7): 837–842.
Louie K. S., Castellsague X., de Sanjose S. et al. Smoking and passive smoking in cervical cancer risk: pooled analysis of couples from the IARC multicentric case- control studies. Cancer Epidemiology, Biomarkers & Prevention. 2011; 20(7): 1379– 1390.
Natphopsuk S., Settheetham-Ishida W., Sinawat S. et al. Risk factors for cervical cancer in northeastern Thailand: detailed analyses of sexual and smoking behavior. Asian Pacific Journal of Cancer Prevention. 2012; 13(11): 5489–5495.
World Health Organization. Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. Geneva, World Health Organization, 2020. Available at: https://www.who.int/publications/i/item/9789240014107 (accessed 17.12.2025).
World Health Organization. WHO Guideline for Screening and Treatment of Cervical Pre-Cancer Lesions for Cervical Cancer Prevention. 2nd ed. Geneva, World Health Organization, 2021. Available at: https://www.who.int/publications/i/ item/9789240030824 (accessed 17.12.2025).
World Health Organization. Human Papillomavirus Vaccines: WHO position paper, December 2022. Weekly Epidemiological Record. 2022; 97(50): 645–672. Available at: https://www.who.int/publications/journals/weekly-epidemiological- record (accessed 17.12.2025).
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