International conference on multidisciplinary science

EARLY DIAGNOSIS OF HPV-ASSOCIATED CERVICAL CANCER AND PRECANCER IN WOMEN AGED 30 AND OLDER

Askarova Z.Z

Bukhara Medical Institute named after Abu Ali Ibn Sina.

Khamidova Sh. Sh.

Bukhara Medical Institute named after Abu Ali Ibn Sina.

Keywords: human papillomavirus, cervical cancer, cervical intraepithelial neoplasia

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Abstract

Long-term studies have established that the human papillomavirus (HPV), which belongs to the papovaviridae family and has a tropism for stratified squamous epithelium, plays a significant role in the etiology of cervical precancer and cancer [2,5]. Most scientists believe that during HPV infection, the viral oncoproteins E6 and E7 lead to genetic instability and epigenetic abnormalities in infected cells, which triggers the process of carcinogenesis and the development of cervical cancer [1,2,4,6]. HPV has been detected in almost 99.8% of cases of invasive cervical carcinoma and in more than 60% of cases of cervical intraepithelial neoplasia [1,3,7]. The period from the primary viral infection to the development of cervical cancer is quite long – 5-10 years, therefore, cervical cancer prevention can be carried out not only by preventing HPV infection (vaccination), but also by early diagnosis of precancerous processes and systemic screening. In those countries where vaccination is carried out, where the quality and prevalence of screening is high, a 90% decrease in the incidence of invasive cervical cancer is noted [2,8,9]. To date, questions about the frequency of screening, the use of markers and methods for diagnosing cervical cancer, especially in the case of transient infection, remain open. The American Society for Colposcopy and Cervical Pathology recommends starting the cervical cancer screening program for women from the age of 21. In Denmark, the age at which screening for cervical cancer begins is 23 years, in France – 25 years, in Finland – 30 years. The issue of the specifics of cervical cancer screening in women under 30 and over 30 years of age remains controversial. To conduct an effective screening test and early diagnosis of cervical cancer, it is necessary to find methods with high specificity and sensitivity. In countries with organized cervical cancer screening based on cytological examination, a decrease in morbidity and mortality from cervical cancer has been shown [2,10]. Cytological examination reveals a large number of patients with L-SIL with ASC-US (squamous epithelial cells with atypia of unknown genesis), L-SIL (low-grade squamous intraepithelial lesions) with a relatively low risk of developing cervical cancer. Detection of H-SIL (high-grade squamous intraepithelial lesions) in patients requires further examination [1,11,12]. It has been established that immunohistochemical (ICC) and immunocytochemical (ICC) studies using double antibodies to p16/Ki67 play an important role in the differential diagnosis of these changes. HPV testing has proven effective in screening women with ASC-US and L-SIL. However, it has been found that HPV infection is unstable in most women under 30 [3,13,14], limiting its use as a primary method for detecting precancerous changes in the cervix. Cervical cancer carcinogenesis is currently understood in terms of the formation of cancer stem cells (CSCs) and spheroid epithelial-mesenchymal structures (SEMS) in tissue.

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