”It’s not alarming that unmarried women as young as their twenties may develop cervical cancer, it’s a fact and I meet such young cervical cancer patients almost every year.” Experts say that cervical cancer is one of the most serious diseases threatening women today, accounting for the second highest incidence of malignant tumors in women, second only to breast cancer. At present, the number of cervical cancer cases worldwide is increasing year by year, and the trend is younger. In China, there are about 131,500 new cases of cervical cancer and nearly 50,000 deaths from cervical cancer each year, and according to WHO, if measures are not taken soon, the number of deaths from cervical cancer will rise by about 25% in the next decade. Human papillomavirus (HPV), the causative agent of cervical cancer, has been clearly stated in the WHO diagnostic criteria for oncology: the necessary condition for cervical cancer is chronic infection with HPV. HPV infection develops into cervical cancer through a long process (cervical atypical hyperplasia → carcinoma in situ → early invasive cancer → cervical cancer), and the CIN (Ⅰ Ⅱ Ⅲ ) classification reflects the gradual evolution of cervical mucosa into invasive cancer after HPV infection. What is HPV, a deoxyribonucleic acid virus that is widely found in nature? According to the literature, HPV infection is present in upwards of 20%-80% of the sexually active population. Up to 150 HPV subtypes have been identified, most of which are low-risk and can only cause benign lesions of the skin and mucous membranes, while high-risk HPV and a few intermediate HPV types can cause malignant lesions. In clinical practice, the most important high-risk types are 8 subtypes such as HPV 16, 18, 52, 58, 31, 33, 56 and 66, and the most important low-risk types are 5 subtypes such as HPV 6, 11, 42, 43 and 81. Low-risk types are the main cause of extra-anal genital warts; while high-risk types such as HPV 16, 18, 33, 31, 52 and 58 are most closely related to cervical cancer. The development of cervical cancer is slow. The development of cervical cancer has a relatively slow process, from atypical hyperplasia to carcinoma, it often takes several years or more than ten years for CIN to break through the subepithelial basement membrane and infiltrate the mesenchyme to form cervical infiltrative cancer. During this time, the lesion is in dynamic change and may disappear completely or may continue to deteriorate. Given that the development of lesions requires a continuous process, we can seize this long progression stage for effective prevention and screening, so as to achieve early detection and timely treatment, thus stopping the further development of cervical lesions. Early asymptomatic screening is important The current main methods of cervical cancer screening are: cervical thin layer liquid-based cytology TCT, or/and HPV screening, and colposcopy if necessary. These two methods are very effective for prevention and early detection of cervical cancer. It is recommended to screen for cervical cancer once a year starting at the age of 25 in economically developed areas and 35 in less economically developed areas. If HPV is negative for 2 consecutive years, the interval between screening can be extended to 3 years, and screening can be stopped around the age of 65. However, high risk signs such as irregular vaginal discharge, contact bleeding and blood in the leukorrhea should be seen at any time. How to determine the real high-risk group As mentioned earlier, about 20-80% of women will be infected with HPV virus once in their lifetime, and about 80% of them can clear the “invader” HPV virus automatically through their own immune mechanism, just like a “chance event”. The same as a “chance event”. However, there are some patients with cervical lesions that have not progressed significantly, such as those with long-standing cervical inflammation and CIN I, who continue to be positive for HPV, which can cause a great deal of panic in patients, resulting in constant testing and unnecessary treatment. So how do you determine which people are really at high risk and need to go for treatment? There are currently two main methods, and those are HPV DNA testing and HPV E6/E7 mRNA testing. The most common method of initial screening used in hospitals today is the HPV-DNA test, which can detect the presence of HPV infection, as well as distinguish whether the infection is a high-risk or low-risk subtype. If you are not infected with HPV, you have a low chance of developing cervical cancer; if you are found to be infected with a high-risk HPV type, you should not panic at all. HPVE6/E7 mRNA test is the most direct means to detect cervical cancer from genetic aspect. This further explains the mechanism of HPV causing cervical cancer. The HPV-E6/E7 mRNA test can detect whether the oncogene of high-risk HPV virus is in the active pathogenic stage to determine whether it is a transient HPV infection, so as to assess the risk and progression of cervical lesions, and to evaluate the prognosis of treated cervical cancer patients.