Рак шейки матки: эпидемиология, факторы риска, скрининг, методы лечения, профилактика и роль искусственного интеллекта

Рак шейки матки (РШМ) остается серьезной глобальной проблемой здравоохранения, особенно в странах с низким и средним уровнем дохода, где доступ к профилактическим мерам и раннему выявлению ограничен. Цель исселедования - обобщить текущие литературные данные о профилактике, скрининге и лечении рака шейки матки, с акцентом на растущую роль искусственного интеллекта (ИИ) в улучшении эффективности методов диагностики и лечения РШМ. Материал и методы. Проведен обзор литературы с использованием рецензируемых статей из Google Scholar, PubMed и Scopus. Поиск был сосредоточен на статьях, посвященных вакцинации против вируса папилломы человека (ВПЧ), методам скрининга рака шейки матки, стратегиям лечения и применению ИИ в лечении рака шейки матки. Результаты. Несмотря на достижения в профилактике и раннем выявлении, рак шейки матки остается основной причиной смертности от рака у женщин, особенно в слаборазвитых регионах. Такие методы скрининга, как мазки Папаниколау, тестирование ДНК ВПЧ и визуальный осмотр с уксусной кислотой (VIA), сыграли важную роль в снижении показателей заболеваемости в развитых странах. Кроме того, программы вакцинации против ВПЧ значительно снизили распространенность инфекций ВПЧ высокого онкогенного риска, что способствовало снижению заболеваемости РШМ. Технологии на основе ИИ, включая алгоритмы глубокого обучения и модели машинного обучения, становятся ценными инструментами в выявлении рака шейки матки, оценке риска и планировании лечения. Эти инновации могут повысить точность диагностики, сократить человеческие ошибки и улучшить результаты лечения, особенно в условиях ограниченных ресурсов. Заключение. Интеграция вакцинации против ВПЧ, передовых методов скрининга и диагностики на основе ИИ представляет собой эффетивный подход к профилактике и лечению рака шейки матки. Будущие исследования должны быть сосредоточены на оптимизации методов ИИ для более широкого клинического использования и обеспечения доступности в регионах с низкими ресурсами.

1. Wang M., Huang K., Wong M.C.S., Huang J., Jin Y., Zheng Z.J. Global Cervical Cancer Incidence by Histological Subtype and Implications for Screening Methods. J Epidemiol Glob Health. 2024; 14(1): 94–101. doi: 10.1007/s44197-023-00172-7.

2. Kavousi S., Maharlouei N., Rezvani A., Akbari Aliabad H., Molavi Vardanjani H. Worldwide association of the gender inequality with the incidence and mortality of cervical, ovarian, endometrial, and breast cancers. SSM Popul Health. 2024; 25. doi: 10.1016/j.ssmph.2024.101613.

3. Shaikh R., Daniel A., Lyng F.M. Raman Spectroscopy for Early Detection of Cervical Cancer, a Global Women's Health Issue-A Review. Molecules. 2023; 28(6). doi: 10.3390/molecules28062502.

4. Momenimovahed Z., Mazidimoradi A., Maroofi P., Allahqoli L., Salehiniya H., Alkatout I. Global, regional and national burden, incidence, and mortality of cervical cancer. Cancer Rep (Hoboken). 2023; 6(3). doi: 10.1002/cnr2.1756.

5. Yao G., Qiu J., Zhu F., Wang X. Survival of Patients With Cervical Cancer Treated With Definitive Radiotherapy or Concurrent Chemoradiotherapy According to Histological Subtype: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2022; 9. doi: 10.3389/fmed.2022.843262.

6. Yadav G., Srinivasan G., Jain A. Cervical cancer: Novel treatment strategies offer renewed optimism. Pathol Res Pract. 2024; 254. doi: 10.1016/j.prp.2024.155136.

7. Wasim T., Mushtaq J., Wasim A.Z., Raana G.E. Gynecological malignancies at tertiary care hospital, Pakistan: A five-year review. Pak J Med Sci. 2021; 37(3): 621–27. doi: 10.12669/pjms.37.3.3596.

8. Hull R., Mbele M., Makhafola T., Hicks C., Wang S.M., Reis R.M., Mehrotra R., Mkhize-Kwitshana Z., Kibiki G., Bates D.O., Dlamini Z. Cervical cancer in low and middle-income countries. Oncol Lett. 2020; 20(3): 2058–74. doi: 10.3892/ol.2020.11754.

9. Sreedevi A., Javed R., Dinesh A. Epidemiology of cervical cancer with special focus on India. Int J Womens Health. 2015; 7: 405–14. doi: 10.2147/IJWH.S50001.

10. Shi J.F., Canfell K., Lew J.B., Qiao Y.L. The burden of cervical cancer in China: synthesis of the evidence. Int J Cancer. 2012; 130(3): 641–52. doi: 10.1002/ijc.26042.

11. Aoki E.S., Yin R., Li K., Bhatla N., Singhal S., Ocviyanti D., Saika K., Suh M., Kim M., Termrungruanglert W. National screening programs for cervical cancer in Asian countries. J Gynecol Oncol. 2020; 31(3). doi: 10.3802/jgo.2020.31.e55.

12. Vali M., Maleki Z., Nikbakht H.A., Hassanipour S., Kouhi A., Nazemi S., Hajizade-Valokolaee M., Nayeb M., Ghaem H. Survival rate of cervical cancer in Asian countries: a systematic review and meta-analysis. BMC Womens Health. 2023; 23(1). doi: 10.1186/s12905-023-02829-8.

13. Park K.J. Cervical adenocarcinoma: integration of HPV status, pattern of invasion, morphology and molecular markers into classification. Histopathology. 2020; 76(1): 112–27. doi: 10.1111/his.13995.

14. Chughtai N., Perveen K., Gillani S.R., Abbas A., Chunara R., Manji A.A., Karani S., Noorali A.A., Zakaria M., Shamsi U., Chishti U., Khan A.A., Soofi S., Pervez S., Samad Z. National cervical cancer burden estimation through systematic review and analysis of publicly available data in Pakistan. BMC Public Health. 2023; 23(1). doi: 10.1186/s12889-023-15531-z.

15. Luvián-Morales J., Gutiérrez-Enríquez S.O., Granados-García V., Torres-Poveda K. Risk factors for the development of cervical cancer: analysis of the evidence. Front Oncol. 2024; 14. doi: 10.3389/fonc.2024.1378549.

16. Perkins R.B., Wentzensen N., Guido R.S., Schiffman M. Cervical Cancer Screening: A Review. JAMA. 2023; 330(6): 547–58. doi: 10.1001/jama.2023.13174.

17. Kashyap N., Krishnan N., Kaur S., Ghai S. Risk Factors of Cervical Cancer: A Case-Control Study. Asia Pac J Oncol Nurs. 2019; 6(3): 308–14. doi: 10.4103/apjon.apjon_73_18.

18. Goldstein A., Gersh M., Skovronsky G., Moss C. The Future of Cervical Cancer Screening. Int J Womens Health. 2024; 16: 1715–31. doi: 10.2147/IJWH.S474571.

19. Shariati Sarcheshme M., Mahdizadeh M., Tehrani H., VahedianShahroodi M. Exploring the barriers to Pap smear test compliance: A qualitative study for improving cervical cancer screening in the primary health care. Health Promot Perspect. 2024; 14(1): 80–88. doi: 10.34172/hpp.42485.

20. Herbst J., Vohl V., Krajina M., Leffers M., Kropidlowski J., Prieske K., Jaeger A., Oliveira Ferrer L., Schmalfeldt B., Goy Y., Burandt E., Pantel K., Vollmert C., Sartori A., Woelber L., Effenberger K., Wikman H. Detection of Multiple HPV Types in Liquid Biopsies of Cervical Neoplasia. Clin Chem. 2024; 70(1): 285–96. doi: 10.1093/clinchem/hvad182.

21. Hu S.Y., Zhao X.L., Zhao F.H., Wei L.H., Zhou Q., Niyazi M., Liu J.H., Wang C.Y., Li L.Y., Cheng X.D., Duan X.Z., Sauvaget C., Qiao Y.L., Sankaranarayanan R. Implementation of visual inspection with acetic acid and Lugol’s iodine for cervical cancer screening in rural China. Int J Gynaecol Obstet. 2023; 160(2): 571–78. doi: 10.1002/ijgo.14368.

22. Gupta P., Faruqi M., Chandra S., Shah S.S., Kulshrestha R. The correlation between colposcopy, cervical cytology, and histopathology in the diagnosis and management of cervical lesions: A cross-sectional study. Int J Reprod Contrac Obstet Gynecol. 2020; 9(7): 2729–35. doi: 10.18203/2320-1770.ijrcog20202539.

23. Wei B., Zhang B., Xue P., Seery S., Wang J., Li Q., Jiang Y., Qiao Y. Improving colposcopic accuracy for cervical precancer detection: a retrospective multicenter study in China. BMC Cancer. 2022; 22(1). doi: 10.1186/s12885-022-09498-0.

24. Kour S., Biswas I., Sheoran S., Arora S., Sheela P., Duppala S.K., Murthy D.K., Pawar S.C., Singh H., Kumar D., Prabhu D., Vuree S., Kumar R. Artificial intelligence and nanotechnology for cervical cancer treatment: Current status and future perspectives. J Drug Delivery Sci Technol. 2023; 83. doi: 10.1016/j.jddst.2023.104392.

25. Park Y.R., Kim Y.J., Ju W., Nam K., Kim S., Kim K.G. Comparison of machine and deep learning for the classification of cervical cancer based on cervicography images. Sci Rep. 2021; 11(1). doi: 10.1038/s41598-021-95748-3.

26. Mustafa W.A., Ismail S., Mokhtar F.S., Alquran H., Al-Issa Y. Cervical Cancer Detection Techniques: A Chronological Review. Diagnostics (Basel). 2023; 13(10). doi: 10.3390/diagnostics13101763.

27. Burmeister C.A., Khan S.F., Schäfer G., Mbatani N., Adams T., Moodley J., Prince S. Cervical cancer therapies: Current challenges and future perspectives. Tumour Virus Res. 2022; 13. doi: 10.1016/j.tvr.2022.200238.

28. Vallejo-Ruiz V., Gutiérrez-Xicotencatl L., Medina-Contreras O., Lizano M. Molecular aspects of cervical cancer: a pathogenesis update. Front Oncol. 2024; 14. doi: 10.3389/fonc.2024.1356581.

29. Bedell S.L., Goldstein L.S., Goldstein A.R., Goldstein A.T. Cervical Cancer Screening: Past, Present, and Future. Sex Med Rev. 2020; 8(1): 28–37. doi: 10.1016/j.sxmr.2019.09.005.

30. Brucker S.Y., Ulrich U.A. Surgical Treatment of EarlyStage Cervical Cancer. Oncol Res Treat. 2016; 39(9): 508–14. doi: 10.1159/000448794.

31. Taliento C., Scutiero G., Arcieri M., Pellecchia G., Tius V., Bogani G., Petrillo M., Pavone M., Bizzarri N., Driul L., Greco P., Scambia G., Restaino S., Vizzielli G. Simple hysterectomy versus radical hysterectomy in early-stage cervical cancer: A systematic review and meta-analysis. Eur J Surg Oncol. 2024; 50(4). doi: 10.1016/j.ejso.2024.108252.

32. Varlas V.N., Borș R.G., Crețoiu R., Bălescu I., Bacalbașa N., Cîrstoiu M. Fertility-sparing surgery: a hopeful strategy for young women with cancer. J Med Life. 2023; 16(7): 974–80. doi: 10.25122/jml-2023-0203.

33. Zakashansky K., Bradley W.H., Chuang L., Rahaman J., Dottino P. Recent advances in the surgical management of cervical cancer. Mt Sinai J Med. 2009; 76(6): 567–76. doi: 10.1002/msj.20149.

34. Grégoire V., Guckenberger M., Haustermans K., Lagendijk J.J.W., Ménard C., Pötter R., Slotman B.J., Tanderup K., Thorwarth D., van Herk M., Zips D. Image guidance in radiation therapy for better cure of cancer. Mol Oncol. 2020; 14(7): 1470–91. doi: 10.1002/1878-0261.12751.

35. Mayadev J.S., Ke G., Mahantshetty U., Pereira M.D., Tarnawski R., Toita T. Global challenges of radiotherapy for the treatment of locally advanced cervical cancer. Int J Gynecol Cancer. 2022; 32(3): 436–445. doi: 10.1136/ijgc-2021-003001.

36. Kwak Y.K., Lee S.W., Kay C.S., Park H.H. Intensity-modulated radiotherapy reduces gastrointestinal toxicity in pelvic radiation therapy with moderate dose. PLoS One. 2017; 12(8). doi: 10.1371/journal.pone.0183339.

37. Moran J.M., Dempsey M., Eisbruch A., Fraass B.A., Galvin J.M., Ibbott G.S., Marks L.B. Safety considerations for IMRT: executive summary. Med Phys. 2011; 38(9): 5067–72. doi: 10.1118/1.3600524.

38. Viswanathan A.N., Moughan J., Small W. Jr., Levenback C., Iyer R., Hymes S., Dicker A.P., Miller B., Erickson B., Gaffney D.K. The quality of cervical cancer brachytherapy implantation and the impact on local recurrence and disease-free survival in radiation therapy oncology group prospective trials 0116 and 0128. Int J Gynecol Cancer. 2012; 22(1): 123–31. doi: 10.1097/IGC.0b013e31823ae3c9.

39. Lazzari R., Riva G., Augugliaro M., Vavassori A., Dicuonzo S., Cattani F., Comi S., Colombo N., Jereczek-Fossa B.A. Intensity modulated radiation therapy boost in locally-advanced cervical cancer in the absence of brachytherapy. Int J Gynecol Cancer. 2020; 30(5): 607–12. doi: 10.1136/ijgc-2019-000735.

40. Wang J., Mao Y., Gao X., Zhang Y. Recurrence risk stratification for locally advanced cervical cancer using multi-modality transformer network. Front Oncol. 2023; 13. doi: 10.3389/fonc.2023.1100087.

41. Yu L., Fei L., Liu X., Pi X., Wang L., Chen S. Application of p16/ Ki-67 dual-staining cytology in cervical cancers. J Cancer. 2019; 10(12): 2654–60. doi: 10.7150/jca.32743.

42. Allanson E.R., Schmeler K.M. Cervical Cancer Prevention in Low- and Middle-Income Countries. Clin Obstet Gynecol. 2021; 64(3): 501–18. doi: 10.1097/GRF.0000000000000629.

43. Abu-Rustum N.R., Yashar C.M., Bean S., et al. NCCN Guidelines Insights: Cervical Cancer, Version 1.2020. J Natl Compr Canc Netw. 2020; 18(6): 660–66. doi: 10.6004/jnccn.2020.0027.

44. Small W. Jr., Bacon M.A., Bajaj A., Chuang L.T., Fisher B.J., Harkenrider M.M., Jhingran A., Kitchener H.C., Mileshkin L.R., Viswanathan A.N., Gaffney D.K. Cervical cancer: A global health crisis. Cancer. 2017; 123(13): 2404–12. doi: 10.1002/cncr.30667.

45. Arbyn M., Weiderpass E., Bruni L., de Sanjosé S., Saraiya M., Ferlay J., Bray F. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020; 8(2). doi: 10.1016/S2214-109X(19)30482-6.

46. Campos N.G., Lowy D.R., de Sanjosé S., Schiffman M. A cervical cancer control strategy for lower-resource settings: interventions to complement one-dose HPV vaccination. J Natl Cancer Inst Monogr. 2024; (67): 417–23. doi: 10.1093/jncimonographs/lgae040.

47. Wu Y., Chen Y., Li L., Yu G., Zhang Y., He Y. Associations of highrisk HPV types and viral load with cervical cancer in China. J Clin Virol. 2006; 35(3): 264–69. doi: 10.1016/j.jcv.2005.07.011.

48. Spayne J., Hesketh T. Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators. BMJ Open. 2021; 11(9). doi: 10.1136/bmjopen-2021-052016.

49. Ronco G., Dillner J., Elfström K.M., Tunesi S., Snijders P.J., Arbyn M., Kitchener H., Segnan N., Gilham C., Giorgi-Rossi P., Berkhof J., Peto J., Meijer C.J.; International HPV screening working group. Efficacy of HPV-based screening for prevention of invasive cervical cancer: followup of four European randomised controlled trials. Lancet. 2014; 383(9916): 524–32. doi: 10.1016/S0140-6736(13)62218-7.

50. Shastri S.S., Temin S., Almonte M., Basu P., Campos N.G., Gravitt P.E., Gupta V., Lombe D.C., Murillo R., Nakisige C., Ogilvie G., Pinder L.F., Poli U.R., Qiao Y., Woo Y.L., Jeronimo J. Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update. JCO Glob Oncol. 2022; 8. doi: 10.1200/GO.22.00217.

51. Han Q., Guo H., Wu Z., Shi J., Zhang X. Efficacy and Safety of 5-Aminolevulinic Acid Photodynamic Therapy for Treating Cervical and Vaginal Intraepithelial Neoplasia. Pharmaceutics. 2024; 16(5). doi: 10.3390/pharmaceutics16050627.

52. Camargo M.J., Russomano F.B., Tristão M.A., Huf G., Prendiville W. Large loop versus straight-wire excision of the transformation zone for treatment of cervical intraepithelial neoplasia: a randomised controlled trial of electrosurgical techniques. BJOG. 2015; 122(4): 552–57. doi: 10.1111/1471-0528.13200.

53. Wentzensen N., Chirenje Z.M., Prendiville W. Treatment approaches for women with positive cervical screening results in lowand middle-income countries. Prev Med. 2021; 144. doi: 10.1016/j.ypmed.2021.106439.

54. Hou X., Shen G., Zhou L., Li Y., Wang T., Ma X. Artificial Intelligence in Cervical Cancer Screening and Diagnosis. Front Oncol. 2022; 12. doi: 10.3389/fonc.2022.851367.

55. Bao H., Bi H., Zhang X., Zhao Y., Dong Y., Luo X., Zhou D., You Z., Wu Y., Liu Z., Zhang Y., Liu J., Fang L., Wang L. Artificial intelligenceassisted cytology for detection of cervical intraepithelial neoplasia or invasive cancer: A multicenter, clinical-based, observational study. Gynecol Oncol. 2020; 159(1): 171–78. doi: 10.1016/j.ygyno.2020.07.099.

56. Allahqoli L., Laganà A.S., Mazidimoradi A., Salehiniya H., Günther V., Chiantera V., Karimi Goghari S., Ghiasvand M.M., Rahmani A., Momenimovahed Z., Alkatout I. Diagnosis of Cervical Cancer and PreCancerous Lesions by Artificial Intelligence: A Systematic Review. Diagnostics (Basel). 2022; 12(11). doi: 10.3390/diagnostics12112771.

57. Wang C.W., Liou Y.A., Lin Y.J., Chang C.C., Chu P.H., Lee Y.C., Wang C.H., Chao T.K.Artificial intelligence-assisted fast screening cervical high grade squamous intraepithelial lesion and squamous cell carcinoma diagnosis and treatment planning. Sci Rep. 2021; 11(1). doi: 10.1038/s41598-021-95545-y.