Chin J Clin Oncol (2008) 5: 1~9
carcinoma in human papillomavirus (HPV)-positive women compared with HPV-negative women was 81.3 (95% CI=42.0~157.1). HPV16 and HPV18 were present in 82% of the patients. HPV appears to be the key risk factor for cervical adenocarcinoma. HPV testing in primary screening using current mixtures of HPV types and HPV vaccination against main HPV types should reduce the incidence of this cancer worldwide. Appleby et al.[54] combined individual data on 13,541 women with and 23,017 women without cer-vical carcinoma, from 23 epidemiological studies. Smokers are at an increased risk of squamous cell (RR=1.95, 95% CI=1.43~2.65), but not of adenocar-cinoma (RR=1.95, 95% CI =1.43~2.65) of the cervix. The risk of squamous cell carcinoma increases in cur-rent smokers with the number of cigarettes smoked per day, and with a younger age at which smoking starts. Plummer et al.[55] reported that smoking in-creases the risk of cervical cancer among HPV posi-tive women.
ScreeningTherapyTzioras, et al.[59] analyzed 65 trials with survival data on 11,180 women to access the effects of different chemotherapy regimens on survival for advanced cervical cancer. The summary relative hazard was 1.02, (95% CI=0.84~1.24) for trials using neo-ad-juvant chemotherapy and 0.85 (95% CI=0.73~1.00) for trials using concurrent chemotherapy. Evidence on chemotherapy in women with advanced cervical cancer is not encouraging for major survival benefits. However, small benefits have been observed in some trials, especially with short-length cycles of cisplatin-based regimens and concurrent chemotherapy and radiotherapy. Current Problems and Future of Evidence-Based Oncology in ChinaOncology is the most updatable science in the medical fields, with the application of new theories, new techniques, new medicines and a huge budget. An incredible quantity of information in oncology and related fields in the changing world will be a terrible burden for medical professional oncologists. The Cochrane Collaboration, evidence-based medicine, systematic reviews and meta-analysis serve the needs of oncologists to catch up on those well-organized knowledge in order to provide the best medical service based on recent evidence for cancer prevention and treatment. Currently in China, there are 3 general problem areas in the development of evidence-based oncol-ogy. First, a lack of knowledge, attitude and a belief that evidence-based oncology will fit the situation for most oncologists in China. The second is a lack of national and international collaboration in evidence-based oncology and a lack of a well-organized pro-fessional team. The third problem area is the discon-nection between research and practice, between the statistician and clinician, and between scientists who conduct research and study the theory of evidence-based oncology and health authorities. To develop evidence-based medicine, a team of re-lated professionals should be established. To train oncologists and standardize clinical pro-cedure with the best evidence-based knowledge, the Chinese version of evidence-based guideline for cancer treatment, screening guideline for cancer early detection and oncology nursing guidelines should be developed. To help people for a healthy and longer life, a healthy life guideline should be developed by medical professionals in different fields including those who work on cancer prevention. Koliopoulos et al.[56] identified 25 studies fulfilling the inclusion criteria. The pooled sensitivity of Hybrid Capture 2(HC2), PCR, cytology [ASCUS (atypical cells of undetermined significance) or worse] and cy-tology [LSIL (low-grade squamous intraepithelial le-sion) or worse] was respectively 90%, 80.9%, 72.7% and 61.6%, and the pooled specificity was respective-ly 86.5%, 94.7%, 91.9% and 96.0%. The combination of HC2 and cytology had the highest sensitivity and lowest specificity, but there was no evidence to con-clude reduction of the incidence of or mortality from invasive cervical cancer among HPV-screened sub-jects compared to cytologically screened subjects. Cuzick et al.[57] summarized the studies on HPV testing in primary cervical cancer screening. HPV testing was substantially more sensitive in detecting CIN2+(moderate dysplasia) than cytology (96.1% vs. 53.0%), but less specific (90.7% vs. 96.3%). The results support the use of HPV testing as the sole primary screening test, with cytology reserved for women who test HPV positive. Bernstein et al.[58] pooled 25 studies to investigate a liquid-based cervical cytological smear study and conventional Papanicolaou smears comparing cyto-logical diagnosis and sample adequacy. The ThinPrep test improved sample adequacy, and led to improved diagnosis of low-grade and high-grade squamous in-traepithelial lesions. No difference was found in the rate of atypical cells of undetermined significance diagnosis between ThinPrep and conventional smear groups.