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3

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, ,

1. 2008, 529.800

, 9%

2, 2012 528.000

266.000 1.

HPV1,3,4 (Human PapillomaVirus),

.

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, ,

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Adjusted Life Years) 6.

1 IARC International Agency for Research on Cancer (2005) IARC Handbooks of Cancer Prevention,

Volume 10, Cervix Cancer Screening. Lyon, France 2 Jemal, A., Bray, F., Center, M.M., et al. (2011) Global cancer statistics. CA Cancer J Clin, 61:69-90

3 IARC International Agency for Research on Cancer (2008) World Cancer Report 2008. Lyon, France

4 Ylitalo, N., Stuver, S., Adami, H.O. (2008) Cervical Cancer. In: Adami HO, Hunter D, Trichopoulos D (eds),

Textbook of Cancer Epidemiology, 2nd

Edition. Oxford University Press, New York, pp.446-467 5 Wells, M., str, A.G., Crum, C.P., et al. (2003) Epithelial tumours. In: Tavassoli FA, Devilee P (eds),

Pathology and Genetics of Tumours of the Breast and Female Genital Organs. IARC Press, Lyon, France, pp.259-279 6 WHO World Health Organization (2008) The global burden of disease: 2004 update. WHO Press,

Switzerland

4

, 2004 480 280

7. 2012,

420 , 5 1.470

210 8,9,

.

1,8, 5

90-95% ,

2.

.

2

(ap test)

HPV

(HPV DNA test).

2.1 ap testing

1.

7 Arbyn, M., Primic-Zakelj, M., Raifu, A.O., et al. (2007) The burden of cervical cancer in South-East Europe

at the beginning of the 21st

Century. Coll.Antropol., 31(2):7-10 8 IARC International Agency for Research on Cancer (2012). GLOBOCAN 2012: Estimated cancer

incidence, mortality and prevalence worldwide in 2012. Available at http://globocan.iarc.fr/Pages/fact_sheets_population.aspx 9 Ferlay, J., Steliarova-Foucher, E., Lortet-Tieulent, J., et al. (2013) Cancer incidence and mortality patterns

in Europe: estimates for 40 countries in 2012. European Journal of Cancer, 49:1374-1403

5

,

.

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HPV DNA test o

1990, HPV

.

,

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, ,

(~70%)

16 18 3,10.

3 ap test HPV DNA test

,

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(primary screening)

.

10

Chan, P.K.S., Picconi, M.A., Cheung, T.H., et al. (2012) Laboratory and clinical aspects of human papillomavirus testing. Critical Reviews in Clinical Laboratory Sciences; 49(4):117-136

6

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.

,

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secondary screening).

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HPV DNA test , 92%.

. 2008,

Cuzick et al.14 CIN2+ 1,

11

Whitlock, E.P., Vesco, K.K., Eder, M., et al. (2011) Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med, 155(10):687-697 12

Cuzick, J., Arbyn, M., Sankaranarayanan, R., et al. (2008) Overview of human papillomavirus-based and other novel options for cervical cancer screening in developed and developing countries. Vaccine, 26(10):29-41 13

Agorastos, T., Chatzistamatiou, K., Katsamagkas, T., et al. (2015) Primary screening for cervical cancer based on High-Risk Human Papillomavirus (HPV) detection and HPV16 and HPV18 genotyping, in comparison to cytology. PLoS ONE, 10(3): e0119755. doi:10.1371/journal. pone.0119755 14

Cuzick, J., Szarewski, A., Mesher, D., et al. (2008) Long-term follow-up of cervical abnormalities among women screened by HPV testing and cytology results from the Hammersmith study. Int J Cancer; 122:2294-2300

7

5 9 0,33%, 0,83%

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3 .

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test.

,

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, HPV DNA test 5

.

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.

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12

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Huh, W., Ault, K.A., Chelmow, D., et al. (2015) Use of primary high-risk human papillomavirus testing for cervical cancer screening: Interim clinical guidance. Gynecol Oncol, http://dx.doi.org/10.1016/j.ygyno.2014.12.022 16

WHO World Health Organization (2013) WHO Guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. WHO Publications, South Africa 17

Castle, P.E., Stoler, M.H., Wright, T.C., et al. (2011) Performance of carcinogenic human papillomavirus (HPV) testing and HPV16 or HPV18 genotyping for cervical cancer screening in women aged 25 years and older: a subanalysis of the ATHENA study. The Lancet Oncology; 12(9):880-890

8

2

, 16 18.

( 1),

, CIN2+

HPV DNA Test 14 hrHPV , 13

HPV16,

CIN2+, .

, ATHENA trial

HPV DNA Test 38,7% ap test

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(co-testing) 96,7%.

, 16 18

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ap test, 3 (positive

predictive value), .

9

,

(HEllenic Real life Multicentric cErvical Screening, HERMES),

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3.2

H

.

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(

)

.

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)

18,19. Vijayaraghavan et al19,

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3 30

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.

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18

Holmes, J., Hemmett, L., Garfield, S. (2005) The cost-effectiveness of human papillomavirus screening for cervical cancer. The European Journal of Health Economics; 6(1):30-37 19

Vijayaraghavan, A., Efrusy, M.B., Mayrand, M.H., et al. (2010) Cost-effectiveness of high-risk human papillomavirus testing for cervical cancer screening in Qubec, Canada. Can J Public Health; 101(3):220-225

10

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Rosmalen et al.20,

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, ATHENA trial21

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(co-testing)

.

4

,

,

.

,

,

20

Van Rosmalen, J., de Kok, I.M., van Ballegooijen, M. (2012) Cost-effectiveness of cervical cancer screening: cytology versus human papillomavirus DNA testing. BJOG; 119(6):699-709 21

Huh, W.K., Williams, E., Huang, J., Bramley, T., Poulios, N. (2014)Cost Effectiveness of Human Papillomavirus-16/18 Genotyping in Cervical Cancer Screening. Appl Health Econ Health Policy DOI 10.1007/s40258-014-0135-4

11

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22

Agorastos T, Chatzistamatiou K, Zafrakas M, Siamanta V, Katsamagkas T, Constantinidis TC,

Lampropoulos AF; LYSISTRATA study group (2014). Epidemiology of HPV infection and current status

of cervical cancer prevention in Greece: final results of the LYSISTRATA cross-sectional study.Eur J

Cancer Prev.23(5):425-31

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