Human papillomavirus and cervical cancer: prevention and treatment with emphasis on low-resource settings
Lynette Denny, Neerja Bhatla and Scott Wittet Key messages
Persistent human papillomavirus infection is responsible for cervical cancer and other cancers including vaginal, penile, anal, oropharyngeal and oral cancers.
At least 13 human papillomavirus types have high potential for causing cancer; two types in particular, HPV-16 and 18, are commonly found in cervical cancers worldwide.
Although there is no cure for HPV infection, the majority of infections clear spontaneously. Progression of persistent infection to cancer, which is relatively uncommon, can be interrupted when pre-cancerous lesions are detected using cytology, visual inspection methods or HPV DNA tests.
Recent developments in cervical cancer prevention (HPV vaccines) open new roads for cervical cancer control worldwide.
The disparities in prevention, screening and treatment between developing and developed countries and between public and private sector markets-remain the greatest challenge to potentially eliminating cervical cancer.
Human papillomavirus
Human papillomavirus (HPV) is easily transmissible and a common sexually transmitted infection (STI). Of more than 100 HPV types, there are at least 13 types of HPV which are known to be carcinogenic. The most important cancer-causing HPV type with regard to cervical cancer is
HPV-85
16, followed by HPV-18. HPV types 16 and 18 are common around the world and account for about 70% of cervical cancer cases. HPV types 6 and 11 do not cause cancer, but are associated with 90% of genital warts. The disease burden of each particular HPV type varies somewhat by region, but HPV-16 and 18 dominate in all regions. Although cervical cancer is the most common malignancy caused by HPV infection, HPV infection is also associated with vaginal, vulvar, penile, anal, oropharyngeal and oral cancers.
Cervical Cancer
Due to the success of pre-cancer screening (primarily using cytology, the
“Pap test”, and adequate management of positive cases) and improved treatment of advanced cancer in industrialised countries, cervical cancer is now a disease primarily of the developing world, where it is the leading cancer killer of women. Nearly 500,000 women develop new cases and about 270,000 women die from cervical cancer each year. Globally, cervical cancer is among the major cancer causes of female mortality and 80 to 85% of these deaths occur in middle- and low-resource countries . Families and communities are severely impacted as they lose mothers, daughters and grand-mothers, women who often are primary caretakers or providers. This is particularly important in areas also devastated by HIV/AIDS, as risk of developing cervical cancer is increased in HIV-positive women.
Case Study Johan Fagan
HPV and cancer of the oropharynx
Smoking and alcohol have long been known to be the major risk factors for oropharyngeal cancer. Infection with human papillomavirus (HPV) infection is now also recognised as an important risk factor in cancers of the oropharynx (oral cavity or throat), such as the tonsils, soft palate and the base of tongue.
Certain HPV types are known to be cancer-causing, specifically HPV type-16 (HPV-16). In the case of oropharyngeal cancers, HPV-16 infection is strongly associated with these cancers, in addition to oral infection with any of 37 types of HPV.
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Transmission of the HPV virus occurs easily through skin-to-skin contact. This mode of transmission is known for other HPV-related cancers such as cervical, vaginal and penile cancers. Oral HPV infection may be sexually acquired and could partially explain the increased incidence of oropharyngeal cancer worldwide.
Determining the HPV status of patients with oropharyngeal cancer may become the standard because of its prognostic implications.
How to utilize this information in practical terms other than counselling sexual partners of HPV-positive patients with oropharyngeal cancer, however, requires further research. Since approximately 90% of oropharyngeal cancers are caused by HPV-16, vaccination could potentially reduce HPV-related oropharyngeal cancer.
Natural History of HPV and Cervical Cancer
HPV spreads through skin-to-skin contact, not in body fluids. It is most commonly spread through any type of sexual contact (penetrative sex as well as any genital, anogenital or orogenital contact). Up to 80% of women are infected with HPV at least once in their lifetime,usually in their teens, 20s, and early 30s. Adolescents who initiate sex at an early age are at especially high risk of infection and for developing persistent infection, because the virus can more easily penetrate an immature cervical epithelium (cell lining of the cervix).
Individuals with multiple sexual partners, or whose partners have many partners, are also at higher risk of infection. While condoms provide protection against other STIs, they are less effective for protection against HPV infection. Therefore, interventions that have proven effective against HIV likely will prove less effective against HPV, and additional protective measures, such as vaccination, are necessary.
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Infection with HPV does not always result in cancer. In fact, the majority of infections clear spontaneously within 3 – 24 months, and in the majority of cases the infection is entirely asymptomatic. In about 10% of women, however, the infection persists. Persistent infection with the cancer-causing types of HPV is strongly correlated with the development of precancerous cervical lesions (pre-cancer), known as low- or high-grade cervical intraepithelial neoplasia, or CIN and also known as squamous intra-epithelial lesions or SIL.
These precancerous lesions can develop into cancer unless detected and removed. Progression from HPV infection to invasive cancer generally takes 20 to 30 years, so cervical cancer is most often diagnosed in women age 40 to 60 years.
HPV infection is a necessary, but not sufficient, cause of cervical cancer.
Factors contributing to the development of cervical cancer after HPV infection includeearly age at first intercourse, multiparity, early age at first delivery, cigarette smoking, long-term hormonal contraceptive use, immune suppression and infection with other STIs such as Chlamydia trachomatis and herpes simplex virus 2.
Screening, diagnosis and treatment of cervical lesions
Cervical cancer is the most preventable of all cancers because the disease develops slowly and treatment of pre-cancerous lesions can be both effective and inexpensive. In high-resource settings, organised cytology-based screening with systematic call, recall, follow-up and surveillance systems have shown the greatest impact on cervical cancer incidence, while using fewer resources than less organised programmes. However, most developing countries have not been able to initiate or sustain Pap-based screening programmes and most women in the world currently have no access to cervical screening. This failure has been due to the demands of competing health needs as well as the challenges of providing cytology services. These challenges include a lack of quality assurance, poor coverage of women at risk, and the failure to follow up women with abnormal Pap smears. The most effective and cost-effective strategies for
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cervical screening are those requiring the fewest patient visits as this improves treatment compliance, follow-up and minimizes cost.
Even screening a woman once in her lifetime, after age 30, and providing treatment as needed, would significantly reduce her risk of cervical cancer.
Large numbers of studies conducted in developing countries (e.g. India, Africa and South America) have shown that alternative strategies to cytology for the prevention of cervical cancer are feasible, effective and relatively easily implemented. Two of the most studied alternatives are visual inspection with acetic acid (known as VIA) and HPV DNA testing.
VIA is a simple low-cost screening method that can give an immediate result and can be linked to rapid treatment. HPV DNA testing has also been studied as a screening test in India and Latin America, can also be linked to rapid treatment, and has been shown to work well in research settings. A low cost,‘field friendly’HPV test may become available as early as 2011.
HPV Vaccination
Currently two vaccines against HPV are available on the global market.
Both prevent infection with the two most common cancer-causing types, HPV-16 and 18. And both vaccines are produced from DNA-free “virus-like particles” (VLPs), which cannot cause HPV infection.
The World Health Organization recommends that routine HPV vaccination be included in national immunisation programmes when:
…prevention of cervical cancer or other HPV-related diseases, or both, constitutes a public health priority; vaccine introduction is programmatically feasible; sustainable financing can be secured; and the cost-effectiveness of vaccination strategies in the country or region is considered. HPV vaccines are most efficacious in females who are naive to vaccine-related HPV types; therefore, the primary target population should be selected based on data on the age of initiation of sexual activity and the feasibility of reaching young adolescent girls through schools, health-care facilities or community-based settings. The primary target population is likely to be girls within the age range of nine or ten years through 13 years.
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The vaccines provide no therapeutic benefit to those already infected with relevant HPV types or those with pre-cancerous lesions or invasive cancer.
Because the vaccines are most effective when given prior to infection, it is recommended that girls are vaccinated beginning at age nine-ten years, when most will not yet have been exposed to HPV infection through sexual activity.
It should be emphasised that while the vaccines represent a major breakthrough in the fight against cancer, up to 30% of cases are the result of other cancer-causing HPV types that are not covered by the current vaccines, though there may be some crossprotection against related HPV types. For this reason, vaccination cannot completely replace screening.
Vaccination – boys and men
Computer modelling of the impact on cervical cancer when vaccinating boys along with girls suggests that the strategy is not cost-effective, except in scenarios of very low vaccine coverage among girls. Furthermore, vaccine efficacy against HPV-16/18-specific pre-cancerous lesions has not yet been demonstrated in men, although protection has been shown against noncancerous genital warts.
Ensuring access to HPV vaccination, cervical screening and treatment programmes
Awareness and coordination of cervical cancer prevention options must be increased globally in order for policy-makers to appropriately prioritise adoption of new cervical cancer prevention interventions. For low-resource countries, vaccination with currently available vaccines will be possible only with substantial vaccine subsidies. The HPV vaccine is one of four vaccines that the GAVI Alliance is considering for subsidised provision to the poorest countries in the world.
Community acceptance of HPV vaccine could be an issue in some places as a result of the stigma around cancer in general, or the nature of how HPV is acquired (i.e. with onset of sexual activity). That said, recent experience of high acceptance of HPV vaccination in Africa, Asia and Latin America suggests that parental concern about cancer, and the desire to protect their
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daughters against it, outweigh other considerations.
Young adolescents do not routinely interact with health systems in most developing countries, and ensuring access to vaccination will be a challenge. Within and among cancer control programmes, traditional efforts have been designed to focus on screening rather than interventions like vaccination. And most other immunization programmes target infants and toddlers, not adolescents. One promising suggestion for reaching eligible girls is to strengthen school health programmes, especially because of the increase in primary school attendance over the past decade. Where many young girls drop out of school at an early age, community programmes might help to fill the gap. The role of the Ministry of Education as well as the importance of culturally appropriate sexual education for all children and adolescents cannot be overstated. Once effective strategies have been developed to reach these girls, additional health interventions appropriate for older children also can be provided that include tetanus, rubella, hepatitis B, measles, and eventually HIV immunisation; deworming;
vitamin A supplementation; malaria intermittent preventive treatment;
provision of bed nets; treatment of schistosomiasis, filariasis, and trachoma;
iron and/or iodine supplementation; nutritional supplementation; and education about hand washing, tobacco, drugs, body awareness, and life-choice decision-making. Using one system to deliver multiple interventions– at the same time as HPV vaccination or at different times–
could increase the cost-effectiveness of all the interventions.
New screening initiatives in places where cytology (Pap test) is not feasible may initially train providers to use visual inspection for primary screening among women aged 30 and older, followed by cryotherapy or other treatment options as indicated. And once a low cost HPV test becomes available, it is possible that it will be used for primary screening, and visual inspection will be employed for treatment triage of women who test positive for the virus. Countries will need to assess and allocate resources for staff training in screening methods and for procurement of cryotherapy equipment and, eventually, HPV tests. This may be a challenge, but advocates may cite mathematical modelling results which clearly show screening to be a costeffective intervention, especially in countries currently paying for treatment of advanced cancer.
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Cervical cancer treatment
Cervical cancer is treated according to the stage of the disease; however not all women with cervical cancer are symptomatic. In the developing world, 75-80% of women with cervical cancer present with late, invasive stages of the disease. The optimal treatment is primary, radical chemoradiation, however access to this treatment is limited in many developing countries.
Only about 20 countries in sub-Saharan Africa have radiation facilities.
When surgery is required, there are few hospitals with the proper facilities and fewer still with the appropriately trained staff to perform the procedure.
Palliative care to avoid unnecessary physical and emotional suffering is a crucial element of cervical cancer control, one that unfortunately is often lacking in developing world settings. Freedom from pain is especially important, but is vastly underutilised, even though pain control can be relatively inexpensive and effective in 90% of cases. In addition, palliative care can be received at home when patients, family and other caregivers receive adequate support, training and supplies.
Lack of appropriately trained professionals extends across the treatment spectrum: the best outcome for women with any cancer is when management is agreed upon by a multidisciplinary team of gynaecological oncologists, radiation oncologists, oncology nurses, pathologists and, of course, the patient and her family. The availability of such comprehensive treatment and qualified personnel almost always decreases when a country has fewer resources overall. This highlights the critical need for adequate and universally available cancer prevention to pre-empt the need for treatment.
Conclusion
There are tremendous disparities in access to cervical cancer prevention between women in industrialised and developing nations. However, innovative technologies to detect HPV and screen for pre-cancer, along with new HPV vaccines, provide exciting new options and aspirations.
Visual inspection and HPV DNA approaches to screening, coupled with simple, and effective treatment methods, make screening every woman at least once in her lifetime a feasible goal.
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The overall assessment from the global scientific community is that HPV vaccines are safe and effective and, ideally they should be offered to girls no matter where they live. There also is consensus that expansion of cervical cancer screening and treatment programmes could result in dramatic declines in mortality in the developing world, just as they already have in wealthier nations.
It is therefore imperative that where cervical cancer is a public health concern, national authorities allocate adequate resources to bring under control this ultimately preventable disease.
HPV-related cancers
Type Incidence per 100,000
Cervix 16.2
Penis 0.0-3.7
Vulva 0.0-3.5
Vagina 0.0-1.5
Anus 0.1-2.8 (males)
0.0-2.2 (females) Oropharynx and tonsils 0.3-21.5 (males)
0.0-2.8 (females)
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SUMMARY
Cervical, oropharyngeal, anal, penile cancer
Viral link Yes
Infectious agent Human papillomavirus
Transmission/vector (as appropriate)
Sexual contact, including skin to skin
Treatment* Yes
HPV
Prevention strategies
Vaccination Early diagnosis Screening
Awarness and education activities;
safe sexual practices yes
yes yes
* Global disparities exist in availability and access to treatment
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ﻲﺒﻄﻟا ﺺﻨﻟا ﺔﻟﺎﺣ ﻲﻓ ﺔﻤﺟﺮﺘﻟا تﺎﯿﻟﺎﻜﺷإ :
أ ﺰﯿﻤﺘﯾ ﻰﻠﻋ ﺔﻤﺋﺎﻘﻟا ﺔﺳﻮﻤﻠﻤﻟا ﺔﯿﻤﻠﻌﻟا ﻖﺋﺎﻘﺤﻟا ﻦﻋ ﺮﺒﻌﺗ ﻲﺘﻟا ﺔﯿﻋﻮﺿﻮﻤﻟﺎﺑ ﻲﺒﻄﻟا ﺺﻨﻟا اﺬھ بﻮﻠﺳ مﺎﻗرﻷﺎﺑ ﻞﯿﻠﻌﺘﻟاو ضﺮﻤﻟﺎﺑ ﻒﯾﺮﻌﺘﻟاو ﺔﻣﺪﻘﻤﻟا ﻦﻣ ﺎﯿﻘﻄﻨﻣ ﻞﺴﻠﺴﺘﻣ ﻞﻜﺷ ﻲﻓ ﻲﻤﻠﻌﻟا ﺞﮭﻨﻤﻟا
ﺔﺻﻼﺨﻟا ﻰﻟإ ﺔﯿﺋﺎﺼﺣﻹا .
ﻠﯾ ﺎﻤﯿﻓو ﻲ ﺔﻐﯿﺼﻟاو بﻮﻠﺳﻷا و ﺐﯿﻛﺮﺘﻟا ﺔﯿﺣﺎﻧ ﻦﻣ ﺔﮭﺟاﻮﻤﻟا تﺎﺑﻮﻌﺼﻟا ﺾﻌﺒﻟ ضﺮﻋ ﺔﯿﺋﺎﮭﻨﻟا
ﺔﻤﺟﺮﺘﻠﻟ :
(1 ﺔﻐﻠﻟا ﻲﻓ ﺎﮭﺘﻏﺎﯿﺻ ﺐﻌﺼﯾ داﺪﻌﺘﻟا بﻮﻠﺳأ ﺎﮭﯿﻓ ﺮﺜﻜﯾ ةﺰﺟﻮﻣ ﺔﯿﻤﺳا ﻞﻤﺟ ﺺﻨﻟا دﻮﺴﯾ
ﺔﯿﻟﺎﺘﻟا ﺔﻠﻤﺠﻟا ﻲﻓ لﺎﺤﻟا ﻮھ ﺎﻤﻠﺜﻣ ﻲﻠﺻﻷا ﺺﻨﻟا ﺐﺗﺎﻛ هﺪﺼﻘﯾ ﺎﻣ ﺪﯾﺪﺤﺗ ﺪﻌﺑ ﻻإ فﺪﮭﻟا :
Ex: "those attending testing and treatment facilities for sexually transmitted diseases such as HIV, drug-abuse treatment and prevention settings, healthcare settings targeting services to injection drug users, healthcare settings targeting services to male homosexuals, and correctional facilities.”
"
رﺎﺒﺘﺧﻻا ﻖﻓاﺮﻣ ﻰﻠﻋ نوددﺮﺘﯾ ﻦﯾﺬﻟا ﻞﺜﻣ سوﺮﯿﻓ ﻞﺜﻣ ﺎﯿﺴﻨﺟ ﺔﻟﻮﻘﻨﻤﻟا ضاﺮﻣﻷا ﻦﻣ جﻼﻌﻟاو
ﺔﯿﺤﺼﻟا ﺔﯾﺎﻋﺮﻟا ﺰﻛاﺮﻣو ،تارﺪﺨﻤﻟا ﻲطﺎﻌﺗ ﻦﻣ ﺔﯾﺎﻗﻮﻟاو جﻼﻌﻟا ﺰﻛاﺮﻣو ،ﻲﻋﺎﻨﻤﻟا زﻮﻌﻟا ﺔﯿﺤﺼﻟا ﺔﯾﺎﻋﺮﻟا ﺰﻛاﺮﻣو ،ﻦﻘﺤﻟا ﻖﯾﺮط ﻦﻋ تارﺪﺨﻤﻟا ﻲطﺎﻌﺘﻣ ﻰﻟإ تﺎﻣﺪﺨﻟا ﻢﯾﺪﻘﺘﻟ ﺔﺼﺼﺨﻤﻟا ﺻﻹا تﺎﺴﺳﺆﻤﻟاو ،ﻦﯿﯿطاﻮﻠﻟا ﻰﻟإ تﺎﻣﺪﺨﻟا ﻢﯾﺪﻘﺘﻟ ﺔﺼﺼﺨﻤﻟا ﺔﯿﺣﻼ
" .
2 ( ﺔﻐﻠﻟا ﻲﻓ ﺎﮭﻟ ﻞﺑﺎﻘﻤﻟﺎﺑ ﺔﯾﺰﯿﻠﺠﻧﻻا ﺔﻤﻠﻜﻟا ﺔﻤﺟﺮﺗ رﺬﻌﺘﯾ ﺎﻣﺪﻨﻋ ﺔﻠﻤﺠﻟا ﺔﻏﺎﯿﺻ ةدﺎﻋإ ﺔﺑﻮﻌﺻ
ﺔﯿﻟﺎﺘﻟا ﺔﻠﻤﺠﻟا ﻲﻓ ءﺎﺟ ﺎﻣ ﻞﺜﻣ ﺔﯿﺑﺮﻌﻟا :
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“Up to 80% of women are infected with HPV at least once in their lifetime, usually in their teens, 20s, and early 30s.”
ﺳاو نﻷ ،ﻰﻟوﻷا ﺔﻠھﻮﻟا ﻲﻓ ﺔﻤﺟﺮﺘﻟا ﺖﺼﻌﺘ "
Teens "
ءاﺪﺘﺑا تاﺮﺸﻌﻟا ﺎﮭﺑ ﺪﺼﻘﯾ ﺔﯾﺰﯿﻠﺠﻧﻹا ﻲﻓ
ﻦﯿﺑ ﺎﻣ حواﺮﺘﻤﻟا ﻦﺴﻟا ﻦﻣ 13
و 19 ﺔﻨﺳ ) ب ﻲﮭﺘﻨﺗ ﻲﺘﻟا ﺔﯾﺰﯿﻠﺠﻧﻹا مﺎﻗرﻷا ﻞﻛ يأ "
Teen ( "
،
لﻮﻘﻟا ﻦﻜﻤﯾ ﻻ ذإ ،ﺎﻀﯾأ ﺔﻘھاﺮﻤﻟا ﻦﺳ ﻮھو "
،تاﺮﺸﻌﻟا ﻦﺳ ﻲﻓ ﺔﺑﺎﺻﻹا هﺬھ نﻮﻜﺗ ﺎﻣ ةدﺎﻋ
ﻨﯾﺮﺸﻌﻟاو تﺎﻨﯿﺛﻼﺜﻟا ﺔﯾاﺪﺑو تﺎ
"
ظﺎﻔﺤﻟا ﻮھ ﺔﻤﺟﺮﺘﻟا ﻦﻣ فﺪﮭﻟا نأ ﺎﻤﺑ و ،ﺔﯿﻓﺮﺣ ﺔﻤﺟﺮﺗ ﺎﮭﻧﻷ
ﻦﻣ ءﺰﺟ لاﺪﺒﺘﺳﺎﺑ ﺔﻠﻤﺠﻟا ﺔﻏﺎﯿﺻ ةدﺎﻋإ ﻦﻣ ﺪﺑ ﻻ نﺎﻛ ﺲﻠﺳ بﻮﻠﺳأ ﻲﻓ ﻲﻠﺻﻷا ﻰﻨﻌﻤﻟا ﻰﻠﻋ ﺔﻠﻤﺠﻟا "
teens, 20s "
ﺔﻐﯿﺼﻟا ﻲﻓ ﺎﮭﺘﻤﺟﺮﺗ ﺖﻧﺎﻛ اﺬﻟ ،ﮫﺗاذ مﻮﮭﻔﻤﻟا ﻰﻠﻋ لﺪﯾ يﺬﻟا ﺊﻓﺎﻜﻤﻟﺎﺑ
ﺔﯿﻟﺎﺘﻟا :
"
ﻧ ﻞﺼﺗ ﻞﻗﻷا ﻰﻠﻋ ةﺪﺣاو ةﺮﻣ يﺮﺸﺒﻟا ﻲﻤﯿﻠﺤﻟا مرﻮﻟا سوﺮﯿﻔﺑ ﺔﺒﺴﻨﺑ ﻦﺒﺼﯾ ﻲﺋﻼﻟا ءﺎﺴﻨﻟا ﺔﺒﺴ
ﻰﻟإ ﻦﮭﺗﺎﯿﺣ ﻲﻓ 80
ﻦﺳ ﻦﯿﺑ ﺔﺣواﺮﺘﻤﻟا ةﺮﺘﻔﻟا ﻲﻓ ﺔﺑﺎﺻﻹا هﺬھ نﻮﻜﺗ ﺎﻣ ةدﺎﻋو ،ﺔﺋﺎﻤﻟا ﻲﻓ
تﺎﻨﯿﺛﻼﺜﻟا ﺔﯾاﺪﺑو ﺔﻘھاﺮﻤﻟا "
(3 ﺎﮭﻌﻣ ﻞﻣﺎﻌﺘﻟا ﻦﻣ ﺪﺑ ﻻ نﺎﻛ ﺐﯿﻛاﺮﺘﻟﺎﺑ ﺔﻘﻠﻌﺘﻣ تﺎﺑﻮﻌﺻ ﻦﻣ ﺺﻨﻟا ﻮﻠﺨﯾ ﻻ ﺎﻤﻛ ،رﺬﺤﺑ
ﺺﻨﻟا ﻲﻓ درو ﺚﯿﺣ :
“Thus, identification of infectious agents in human cancer, prevention, detection and treatment of these infections need to be the focus of current cancer research.”
ﺎﮭﺘﻤﺟﺮﺗ ﺖﻧﺎﻛو :
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"
ﺤﻓﺎﻜﻣ لﺎﺠﻣ ﻲﻓ ﺔﯾرﺎﺠﻟا ثﻮﺤﺒﻟا ﺰﻛﺮﺗ نأ ﻲﻐﺒﻨﯾ ،اﺬﻜھو ﻰﻠﻋ ﺮﺿﺎﺤﻟا ﺖﻗﻮﻟا ﻲﻓ نﺎطﺮﺴﻟا ﺔ
ﺎﮭﻨﻋ ﻒﺸﻜﻟاو ﺎﮭﻨﻣ ﺔﯾﺎﻗﻮﻟاو نﺎطﺮﺴﻟﺎﺑ نﺎﺴﻧﻹا ﺔﺑﺎﺻإ ﻰﻟإ ﺔﯾدﺆﻤﻟا ﺔﯾﺪﻌﻤﻟا ﻞﻣاﻮﻌﻟا ﺪﯾﺪﺤﺗ ﺎﮭﺟﻼﻋو ".
ﺖﻧﺎﻛ ﻻإو ﺎﮭﺘﻤﺟﺮﺗ ﺪﻨﻋ ﮫﯿﻠﻋ ﻲھ ﺎﻣ ﻰﻠﻋ ﺔﯾﺰﯿﻠﺠﻧﻹا ﺔﻐﯿﺼﻟا ءﺎﻘﺑإ ﺔﻟﺎﺤﻟا هﺬھ ﻲﻓ ﻦﻜﻤﯾ ﻻ ﮫﻧﻷ قﺎﯿﺳ ﻲﻓ دﻮﺼﻘﻤﻟا ﻰﻨﻌﻤﻟا مﺮﺘﺤﺗ ﻻ ﺔﯿﻓﺮﺣ ﺔﻤﺟﺮﺗ ﻲﻠﺻﻷا ﺺﻨﻟا
ﺮﯿﺧﺄﺘﻟاو ﻢﯾﺪﻘﺘﻟا ﻦﻣ ﺪﺑ ﻻ نﺎﻜﻓ .
ﺔﯿﺑﺮﻌﻟا ﺔﯾﻮﺤﻨﻟا ﺐﯿﻛاﺮﺘﻟا ﮫﺑ ﺢﻤﺴﺗ ﺎﻤﻟ ﺎﻘﻓو ﻒﻠﺘﺨﻣ بﻮﻠﺳأ ﻲﻓ ﺔﻠﻤﺠﻟا ءاﺰﺟأ ﻦﯿﺑ .
4 ( ﻦﻋ ﻦھﺮﺒﯾو ﺎﮭﺑ لﺪﺘﺴﯿﻟ ﺔﯾﻮﺌﻣ ﺐﺴﻧ ﻦﻣ ﺔﯿﺿﺎﯾﺮﻟا تﺎﯿﺋﺎﺼﺣﻹا ﻲﺒﻄﻟا ﺺﻨﻟا اﺬھ مﺪﺨﺘﺴﯾ
ﻊﻣ ﺔﻠﻤﺠﻟا ﺔﻏﺎﯿﺻ ةدﺎﻋإ ﺐﻌﺼﯾ ﻦﻜﻟ ،ﻖﯿﻗد ﻞﻜﺸﺑ ﺔﯿﻤﻠﻌﻟا ﺔﻘﯿﻘﺤﻟا ﺔﯾﻮﺌﻤﻟا ﺐﺴﻨﻟا هﺬھ جاردإ
ﻲﻠﯾ ﺎﻤﯿﻓ لﺎﺤﻟا ﻮھ ﺎﻤﻠﺜﻣ ،ﮫﯿﻓ تءﺎﺟ يﺬﻟا قﺎﯿﺴﻟا ﻲﻓ :
"Among children under 5 years of age who become infected, fewer than 10% are symptomatic whereas 80-90% of infants infected during the first year of life and 30-50% of children infected between one and four years of age develop the chronic condition."
ﺔﻣﺟرﺗﻟا :
"
ضﺮﻤﻟا ضاﺮﻋأ ﺮﮭﻈﺗ ﻰﻠﻋ
ﺔﺒﺴﻧ ﻦﻋ ﻞﻘﺗ 10
ﻦﯿﺑﺎﺼﻤﻟا لﺎﻔطﻷا ﻦﻣ ﺔﺋﺎﻤﻟا ﻲﻓ ﻞﻘﺗو ىوﺪﻌﻟﺎﺑ
تاﻮﻨﺳ ﺲﻤﺧ ﻦﻋ ﻢھرﺎﻤﻋأ ،
لﻼﺧ ﻦﻣﺰﻤﻟا ضﺮﻤﻟﺎﺑ ﻦﯿﺑﺎﺼﻤﻟا ﻊﺿﺮﻟا ﺔﺒﺴﻧ حواﺮﺘﺗ ﻦﯿﺣ ﻲﻓ
ﻦﻣ ﻰﻟوﻷا ﺔﻨﺴﻟا ﻦﯿﺑ ﻢﮭﺗﺎﯿﺣ
و 80 ﻦﯿﺑو ﺔﺋﺎﻤﻟا ﻲﻓ 90 و 30
لﺎﻔطﻷا ﺪﻨﻋ ﺔﺋﺎﻤﻟا ﻲﻓ 50
تاﻮﻨﺳ ﻊﺑرأو ﺔﻨﺴﻟا ﻦﯿﺑ ﻢھرﺎﻤﻋأ نﻮﻜﺗ ﻦﯾﺬﻟا ﻦﻣﺰﻤﻟا ضﺮﻤﻟﺎﺑ ﻦﯿﺑﺎﺼﻤﻟا ".
97
،ﺔﯿﻋﻮﺿﻮﻤﻟاو ﺔﻗﺪﻟا ﻰﻠﻋ ﺎﺻﺮﺣ ﺔﻠﻣﺎﻛ ةﺪﺣﻮﻛ ﺔﻠﻤﺠﻟا ﺔﻤﺟﺮﺗ ﻲﻓ فﺮﺼﺘﻟا يروﺮﻀﻟا ﻦﻣ نﺎﻛ ﻟاو ﺮﯿﺧﺄﺘﻟاو ﻢﯾﺪﻘﺘﻟا ماﺪﺨﺘﺳا ﻰﻟإ ءﻮﺠﻠﻟا نﺎﻛ اﺬﮭﻟ ﺢﻤﺴﺗ ﺎﻤﻟ ﺎﻘﻓوو ﻰﻨﻌﻤﻠﻟ ﺎﻘﯿﻘﺤﺗ ﺔﻤﺟﺮﺘﻟا ﻲﻓ ﻲﻔﻨ
فﺪﮭﻟا ﺺﻨﻟا ﻲﻓ ﺔﯾﻮﻐﻠﻟا ﺐﯿﻛاﺮﺘﻟا ﮫﺑ .
ﺔﻓﺎﺿإ ﻲﻀﺘﻘﺗ ﺔﯾﻮﺌﻤﻟا ﺐﺴﻨﻟا نأ ﺎﻤﻛ
"
ﺔﺒﺴﻧ حواﺮﺘﺗ "...
ﺎﻘﺑﺎﺳ ﻢﺟﺮﺘﻣ ﻮھ ﺎﻤﻠﺜﻣ فﺪﮭﻟا ﺺﻨﻟا ﻲﻓ ﻰﻨﻌﻤﻟا ﻂﯿﺴﺒﺗو حﺮﺷ ﺔﯿﻐﺑ ﺔﻠﻤﺠﻟا هﺬھ ﻲﻓ .
ﺖﺣﺮط ﻲﺘﻟا ﺔﺼﺘﺨﻤﻟا ﻢﯿھﺎﻔﻤﻟا ﻦﻣ ادﺪﻋ ﺺﻨﻟا اﺬھ ﻦﻤﻀﺗ ﺎﻤﻛ ،ﺔﯿﺑﺮﻌﻟا ﺔﻐﻠﻟا ﻰﻟإ ﺎﮭﻠﻘﻧ ﺔﺑﻮﻌﺻ
ﺺﻨﻟا ﻲﻓ تءﺎﺟ ﺎﻤﻛ :
1 ﺢﻠﻄﺼﻣ درو ( "
INFECTION "
روﺪﯾ عﻮﺿﻮﻤﻟا ﻞﻛ نﻷ ﺺﻨﻟا ﻲﻓ ةﺮﻣ ﻦﻣ ﺮﺜﻛأ
؟ﻢﺟﺮﺘﯾ ﻒﯿﻛو ؟هﺎﻨﻌﻣ ﺎﻤﻓ ،ﮫﻟﻮﺣ
ﻆﻔﻠﻟ ﺔﯿﺑﺮﻌﻟا ﺔﻐﻠﻟﺎﺑ ﻞﺑﺎﻘﻣ ﻦﻋ ﺎﺜﺤﺑ ﺔﻣﺪﺨﺘﺴﻤﻟا ﻢﺟﺎﻌﻤﻟا حﺮﺘﻘﺗ "
Infection "
ظﺎﻔﻟﻷا ﻦﻣ ادﺪﻋ
،قﺎﯿﺴﻟا ﻦﻋ لﺰﻌﻣ ﻲﻓ ﻰﻘﺒﺗ ﺰﻛﺮﯾ يﺬﻟا صﺎﺼﺘﺧﻻا ﺔﻐﻟ مﺎﻈﻧ ﻰﻟإ ﻲﻤﺘﻨﯾ ﻲﻤﻠﻌﻟا ﺢﻠﻄﺼﻤﻟا نأ ﻻإ
ﺐﺳﺎﻨﻤﻟا ﺊﻓﺎﻜﻤﻟا دﺎﺠﯾإو ﮫﻣﻮﮭﻔﻣ ﺪﯾﺪﺤﺗ ﻞﺟأ ﻦﻣ ﺢﺿاوو ﻖﯿﻗد ﻞﻜﺸﺑ ﺢﻠﻄﺼﻤﻟا ﻒﯾﺮﻌﺗ ﻰﻠﻋ ﮫﯿﻟإ ﻲﻤﺘﻨﯾ يﺬﻟا قﺎﯿﺴﻠﻟ .
ﺢﻠﻄﺼﻣ ﻒﯾﺮﻌﺗ ءﺎﺟ
"
infection "
ﻲﺒﻄﻟا ﻢﺠﻌﻤﻟا ﻲﻓ )
(https://merriam-webster.com/dictionary ﻲﺗﻷﺎﻛ
:
ﻞﺜﻣ ﻢﯿﻠﺳ ﻢﺴﺟ ﻰﻟإ تﺎﺳوﺮﯿﻔﻟاو ﻢﯿﺛاﺮﺠﻟا ﻞﺜﻣ ﺔﻘﯿﻗد تﺎﻨﺋﺎﻛ لﺎﻘﺘﻧا ﻮھ :
" Furthermore, where prevention prior to infection (i.e. through vaccination) is not available or possible,…"
ﻞﺜﻣ ﺎﻀﯾأ ﻢﺴﺠﻟا ﻲﻓ ﺎھﺮﺛﺎﻜﺗو ﺔﻘﯿﻗﺪﻟا تﺎﻨﺋﺎﻜﻟا لﺎﻘﺘﻧا ﻦﻋ ﺞﺗﺎﻨﻟا ضﺮﻤﻟﺎﺑ فﺮﻌﯾو :
98
"Chronic hepatitis B infection is a long term hepatitis B liver inflammation that may never completely resolve itself."
اﺬﮭﻟ ﺔﻐﻠﻟا ﻲﺋﺎﻨﺛ ﺪﺣاﻮﻟا ﻢﺠﻌﻤﻟا ﺎﮭﺣﺮﺘﻘﯾ ﻲﺘﻟا تﻼﺑﺎﻘﻤﻟا ﻦﻣ ﻢﮭﻤﻟا دﺪﻌﻟا ﻲﻟﺎﺘﻟا لوﺪﺠﻟا ﺢﺿﻮﯾو immune, while others develop chronic HBV infection, which can lead to the serious consequences of cirrhosis and liver cancer.
ﺪﻌﺑو
99
"The Pattern of cancer sites also varies substantially from region to region. "
ﺢﻠﻄﺼﻤﻟا نأ ﻖﯿﻗﺪﺘﻟا ﺪﻨﻋ ﺔﻈﺣﻼﻤﻟا ﻦﻜﻤﯾ ﻦﻜﻟ ،ﺔﻠھو لوﻷ ﺔﻣﻮﮭﻔﻣ ﺔﻠﻤﺠﻟا وﺪﺒﺗ
Radiofrequency ablation "
ﻦﻣ ﺚﻟﺎﺜﻟا ﻞﺼﻔﻟا ﻲﻓ ،ﺺﻨﻟا
ﺪﻌﺑ ﺎھرﺎﺸﺘﻧا مﺪﻋو ﺔﯿﻨﻘﺘﻟا ﺔﺛاﺪﺤﻟ اﺮﻈﻧ ﺔﯿﺑﺮﻌﻟا ﺔﻐﻠﻟﺎﺑ ﻞﺑﺎﻘﻣ ﺪﺟﻮﯾ ﻻ ﮫﻧﻷ ﮫﺘﻤﺟﺮﺗ ﺖﺼﻌﺘﺳاو
100
Radiofrequency ablation "
“Noteworthy contributions to liver cancer causation derive from afatoxin contamination of food in less developed equatorial countries, and from dietary and metabolic factors (i.e., obesity, diabetes, and iron overload) in more developed countries.”
"
metabolic "
101
ﻲﻓ ﻞﻠﺧ ﻦﻋ ﺔﻤﺟﺎﻨﻟا ضاﺮﻣﻷا "
metabolism "
ﻤﯾﺰﻧﻷا ﻲﻓ ﻞﻠﺧ عﻮﻗو يأ ﻲﻓ ﻞﺧﺪﺗ ﻲﺘﻟا تﺎ
ﻒﯾﺮﻌﺘﻟا ﻲﻓ ﻖﺒﺳ ﺎﻤﻠﺜﻣ ﻲﺋﺎﯿﻤﯿﻜﻟا ﻞﻋﺎﻔﺘﻟا .
نإ ﺐﻨﺠﺗ ﮫﺣﺎﻀﯾإ ﻲﻓ ةدﺎﯾﺰﻟاو ﺢﻠﻄﺼﻤﻟا ﺮﯿﺴﻔﺗ
ﺚﺤﺒﻟا ةﺎﻧﺎﻌﻣ ئرﺎﻘﻟا .
5 ( ﺢﻠﻄﺼﻣ درو "
iron overload "
ﻲﺒﻄﻟا ﻢﺠﻌﻤﻟا ﻲﻓ ﮫﻠﺑﺎﻘﯾو ،ﻦﯿﺘﻤﻠﻛ ﻦﻣ نﻮﻜﺘﻤﻟا
ﺢﻠﻄﺼﻣ ﺔﯿﺑﺮﻌﻟا ﺔﻐﻠﻟﺎﺑ ﺪﺣﻮﻤﻟا
"
يﻮﻣد ﻲﻏﺎﺒﺻ ءاد "
مﻮﮭﻔﻤﻟا ﺲﻜﻌﯾ ﻻ يﺬﻟا ﻰﻠﻋ لاﺪﻟا
تﺎﻤﻠﻛ ﺖﺳ ﻲﻓ ﮫﺘﻤﺟﺮﺗ ﺖﻧﺎﻛ اﺬﮭﻟو ﻲﺑﺮﻌﻟا ئرﺎﻘﻟا ﺪﻨﻋ ضﺮﻤﻟا
"
ﺪﯾﺪﺤﻟا ﺐﺳﺮﺗ ضﺮﻣ
مﺪﻟا ﻲﻓ ﺪﺋاﺰﻟا
"
ﻂﯿﺴﺒﺘﻟاو حﺎﻀﯾﻹا ةدﺎﯾزو ﺮﯿﺴﻔﺘﻟﺎﺑ ﮫﯿﻠﻋ لاﺪﻟا مﻮﮭﻔﻤﻟا ﺢﯿﺿﻮﺗ ﺔﯿﻐﺑ ، .
102
ﺔﺻﻼﺨﻟا
ﺴﻔﺗ ةﺪﻋ ﻞﻤﺘﺤﯾ ﻻ ﺮﺷﺎﺒﻣو ﻖﯿﻗد ﻲﻋﻮﺿﻮﻣ ﺺﻧ ﻲﺒﻄﻟا ﺺﻨﻟا نأ مﺪﻘﺗ ﺎﻤﻣ جﺎﺘﻨﺘﺳﻻا ﻦﻜﻤﯾ تاﺮﯿ
ةدﺪﺤﻤﻟا ﺔﯿﻤﻠﻌﻟا ﻖﺋﺎﻘﺤﻟا ﻢﯿھﺎﻔﻣ ﻰﻠﻋ لﺪﺗ ﺔﻘﯿﻗد تﺎﺤﻠﻄﺼﻣ ﻦﻣ ﮫﯿﻓ ﺎﻤﻟ .
ﻰﻟإ جﺎﺘﺤﺗ ﮫﺘﻤﺟﺮﺗ نأ ﻻإ
ﻞﻛ ءارو ﻦﻣﺎﻜﻟا ﻰﻨﻌﻤﻟا جاﺮﺨﺘﺳا ﺔﯿﻐﺑ ﺾﻣﺎﻏ ﻮھ ﺎﻣ حﺮﺷو ﺚﺤﺒﻟاو ﻞﯿﻠﺤﺘﻟاو ﺮﯿﺴﻔﺘﻟا ﻞﺜﻣ ﺎﮭﻌﻣ ﻞﻣﺎﻌﺘﻟا ﺔﯿﻔﯿﻛو ،ﺺﻨﻟا ﻲﻓ ةدﻮﺟﻮﻤﻟا تارﺎﺒﻌﻟا ﻦﻣ دﻮﺼﻘﻤﻟاو تﺎﺤﻠﻄﺼﻤﻟا ﻲﺘﻟا تﺎﺤﻠﻄﺼﻤﻟا ﻨﯿﺗﻼﻟاو ﻲﻧﺎﻧﻮﯿﻟا ﻞﺻﻷا ﻰﻟإ ﺎھروﺬﺟ دﻮﻌﺗ
ﻲ ﻢﻠﻋ ﻢﺳا ﻦﻣ ﺔﻧﻮﻜﺘﻤﻟاو
ﻰﺘﺣ ﺎﮭﻣﻮﮭﻔﻣو ﺎﮭﻠﺻأ ﻲﻓ ﻖﻤﻌﻤﻟا ﺚﺤﺒﻟا ﺐﻠﻄﺘﺗ ﺔﯿﺒﻄﻟا تﺎﺤﻠﻄﺼﻤﻟا نأ ﻦﯿﺒﺗ ﺪﻗو ،تاﺮﺼﺘﺨﻣو ﻟﺎﺘﻟﺎﺑو ﺎﮭﻨﻣ ﻮﺟﺮﻤﻟا ﻰﻨﻌﻤﻟا ﻊﯿﻀﯾ ﻻ ﻲ
فﺪﮭﻟا ﺔﻐﻠﻟا ﻲﻓ ﺎﮭﺘﻏﺎﯿﺻ ةدﺎﻋإو ﺎﮭﻄﯿﺴﺒﺗ ﻢﺟﺮﺘﻤﻠﻟ ﻦﻜﻤﯾ .
ا ﺔﯾﺮﻈﻨﻟﺎﺑ ﺔﻧﺎﻌﺘﺳﻻا نإ زوﺎﺠﺗ ﻲﻓ راﺮﯾﺪﯿﻟ ﮫﺘﻌﺿو يﺬﻟا بﻮﻠﺳﻷاو ،ﺚﺤﺒﻟا ﻲﻓ ﺔﯾﺮﯿﺴﻔﺘﻟ
ﻲﻠﺻﻷا ﺺﻨﻟا ﻲﻓ دﻮﺼﻘﻤﻟا ﻰﻨﻌﻤﻟا كاردإ ﻲﻓ ﺔﻠﺜﻤﺘﻤﻟاو ﺔﯿﻠﻤﻌﻟا ﺔﯿﺣﺎﻨﻟا ﻦﻣ ﺔﻤﺟﺮﺘﻟا تﺎﺑﻮﻌﺻ ﺔﻤﺟﺮﺗ ﻢﺳﻼط ﻚﻓ ﻲﻓ اﺮﯿﺜﻛ ﺎﻤھﺎﺳ ﺪﻗ فﺮﺼﺘﻟاو ﺢﯿﺿﻮﺘﻟﺎﺑ فﺪﮭﻟا ﺺﻨﻟا ﻲﻓ ﮫﻟ ﺊﻓﺎﻜﻤﻟا دﺎﺠﯾإو ﻟا هﺬﮭﻟ ضﺮﻋ ﻲﻠﯾ ﺎﻤﯿﻓو ،ﺚﺤﺒﻟا اﺬھ ﺺﻧ ﺎھزوﺎﺠﺗ ﺔﯿﻔﯿﻛو تﺎﺑﻮﻌﺼ
:
ﺮﺧآ مﻮﮭﻔﻣ ﻰﻠﻋ لﺪﺗ ﺪﻘﻓ ﻲﻠﺻﻷا ﻰﻨﻌﻤﻟا ﻲﻓ ﺎﮭﺘطﺎﺴﺑ ﻢﻏر ﻲﺘﻟا ﺔﯿﺒﻄﻟا صﻮﺼﻨﻟا ﻲﻓ ةرﺎﻌﺘﺳﻻا ﺔﻧﺎﻌﺘﺳا ﺢﻠﻄﺼﻤﻟا ﻰﻨﻌﻣ ﻂﺒﺿو ﻢﯿھﺎﻔﻤﻟا ﻲﻓ ﻖﯿﻗﺪﺘﻟا ﺐﺠﯾ ﻚﻟﺬﻟ ،ﮫﯿﻟإ ﻲﻤﺘﻨﺗ يﺬﻟا قﺎﯿﺴﻟا ﻲﻓ قﺎﯿﺴﻟﺎﺑ .
ﻲھو ،ﺔﯿﺑﺮﻌﻟا ﺔﻐﻠﻟا ﻲﻓ ﺎﮭﻟ ﻞﺑﺎﻘﻣ ﻻ ﻲﺘﻟا ةﺪﯾﺪﺠﻟا تﺎﺤﻠﻄﺼﻤﻟا ﺚﺤﺒﻟا ﻲﻐﺒﻨﯾ ﺎﻀﯾأ ةﺪﯾﺪﺟ ﻢﯿھﺎﻔﻣ
مﻮﮭﻔﻤﻟا ﻰﻠﻋ لﺪﯾ ﻞﺑﺎﻘﻣ ﻰﻟإ لﻮﺻﻮﻟاو ﺎﮭﻛاردإ ﻞﺟأ ﻦﻣ ﺔﯿﻠﺻﻷا ﺎﮭﺘﻐﻟ ﻲﻓ دﺪﺤﻤﻟا ﺎﮭﻔﯾﺮﻌﺗ ﻦﻋ ﺔﯿﻠﺻﻷا ﺔﻐﻠﻟا ﻲﻓ ﮫﺗاذ .
103
،تﺎﻤﺟﺮﺗ ةﺪﻋ ةﺪﺣاﻮﻟا ﺔﻤﻠﻜﻠﻟ نﻮﻜﯾ نأ ﻮھو ،ﺪﺣاﻮﻟا ﺢﻠﻄﺼﻤﻠﻟ فﺪﮭﻟا ﺔﻐﻟ ﻲﻓ تﻼﺑﺎﻘﻤﻟا دﺪﻌﺗ
ﺬﮭﻟو ،ﺎﮭﻟ ﺐﺴﻧﻷا ﻞﺑﺎﻘﻤﻟا رﺎﯿﺘﺧا ﺐﻌﺼﯾ ﮫﯿﻟإ ﻲﻤﺘﻨﯾ يﺬﻟا قﺎﯿﺴﻟاو ﺚﺤﺒﻟﺎﺑ ﺔﻧﺎﻌﺘﺳﻻا ﻦﻣ ﺪﺑﻻ ا
ﻢﺟﺮﺘﻤﻟا ﮫﯿﻟإ ﻞﺼﯾ يﺬﻟا ﺮﯿﺴﻔﺘﻟا ﺐﺴﺤﺑ داﺮﻤﻟا مﻮﮭﻔﻤﻟا ﺪﯾﺪﺤﺗ ﻞﺟأ ﻦﻣ ﺺﻨﻟا .
،ﺔﯿﺑﺮﻌﻟا ﺔﻐﻠﻟا ﻲﻓ ﺔﺒﯾﺮﻐﻟا تﺎﺤﻠﻄﺼﻤﻟﺎﺑ ﺮﻣﻷا ﻖﻠﻌﺘﯾو ،ﮫﻣﻮﮭﻔﻣ ﻊﻣ ﺢﻠﻄﺼﻤﻟا ﺔﯿﻤﺴﺗ قﺎﺴﺗا مﺪﻋ
ﯿﻤﻠﻌﻟا ﺔﻘﯿﻘﺤﻟا ﻰﻠﻋ لﺪﺗ ﻻ ﺚﯿﺤﺑ ضﻮﻤﻐﻟا ﺎھدﻮﺴﯾ ﻲﺘﻟاو ،ئرﺎﻘﻟا ﻦھذ ﻲﻓ ﻖﯿﻗدو ﺢﺿاو ﻞﻜﺸﺑ ﺔ
ﺔﻣﺎﻋ لوﺎﻨﺘﻣ ﻲﻓ نﻮﻜﺗو ﺎﮭﻤﮭﻓ ﻞﮭﺴﯾ ﻰﺘﺣ ﺎﮭﻣﻮﮭﻔﻣ ﺔﻏﺎﯿﺻ ةدﺎﻋإو ﺎﮭﻄﯿﺴﺒﺗو ﺎﮭﺣﺮﺷ ﻲﻐﺒﻨﯾ سﺎﻨﻟا .
ﻊﺿو ﻲﻓ ﺚﺤﺒﻟا اﺬھ ﺎﮭﯿﻠﻋ ﺪﻤﺘﻋا ﻲﺘﻟا ﻲﺒﻄﻟا لﺎﺠﻤﻟا ﻲﻓ ﺔﻐﻠﻟا ﺺﺋﺎﺼﺧ ﺪﯾﺪﺤﺘﺑ مﺎﻤﺘھﻻا ﻦﻤﻜﯾ ﯿﺑ ﺎﻤﯿﻓ ﻞﺻاﻮﺘﻟا ﻞﺟأ ﻦﻣ صﺎﺼﺘﺧﻻا ﻞھأ ﺎﮭﻣﺪﺨﺘﺴﯾ ﺔﯿﺠﮭﻨﻣ ﺲﺳأ ﺔﻗﺪﻟا ﻦﻣ ﺪﯿﻔﻤﻟا رﺎﺼﺘﺧﻻﺎﺑ ﻢﮭﻨ
زﺎﺠﯾﻹاو حﻮﺿﻮﻟاو ﺔﻐﻠﻟ نﻮﯿﺋﺎﺼﺧﻷا ﺎﮭﻌﺿو ﻲﺘﻟا ﺮﯿﯾﺎﻌﻤﻟا نأ ﻦﯿﺒﺗ ،عﻮﺿﻮﻤﻟا ﻲﻓ مﺪﻘﺘﻟا ﻊﻣو .
ﻲﻓ ﻲﺑﺮﻌﻟا ﺺﻨﻟا ﻰﻠﻋ ﻊﻗاﻮﻟا ﻲﻓ ﻖﺒﻄﻨﺗ ﻻ ﺎﮭﻨﻜﻟ يﺰﯿﻠﺠﻧﻻا ﺺﻨﻟا ﻰﻠﻋ ﻖﺒﻄﻨﺗ ﺔﺼﺼﺨﺘﻤﻟا ﻲﺒﻄﻟا لﺎﺠﻤﻟا .
ﺨﻟا هﺬھ ةﺎﻋاﺮﻣ نﺎﻜﻣﻹا رﺪﻗ لوﺎﺤﯾ ﻢﺟﺮﺘﻤﻟا نﺎﻛ اذإو ﺔﻗﺪﻟا ةﺎﻋاﺮﻣ نﺈﻓ ،ﺺﺋﺎﺼ
نﻮﻜﯾ ﻰﺘﺣو دﻮﺼﻘﻤﻟا ﺆﻓﺎﻜﺘﻟا ﻖﯿﻘﺤﺗ ﻞﯿﺒﺳ ﻲﻓ ﻞﯿﺤﺘﺴﺗ دﺎﻜﺗ ﺔﻟﺄﺴﻣ ﺪﺣاﻮﻟا ﺺﻨﻟا ﻲﻓ زﺎﺠﯾﻹاو ﺎﻤﻨﯿﺑ حﺮﺸﻟا ﻲﻓ ةدﺎﯾﺰﻟاو حﻮﺿﻮﻟاو ﻞﯿﻠﺤﺘﻟا ﺐﻠﻄﺘﺗ ﺔﻗﺪﻟا نﻷ ،سﺎﻨﻟا ﺔﻣﺎﻋ لوﺎﻨﺘﻣ ﻲﻓ ﺺﻨﻟا ﻋ ﺮﯿﺒﻌﺘﻠﻟ ﺔﻨﻜﻤﻤﻟا زﻮﻣﺮﻟا وأ ظﺎﻔﻟﻷا ﻞﻗﺄﺑ ﺮﺼﺘﺨﻤﻟا ﻒﺻﻮﻟا زﺎﺠﯾﻹا ﻲﻀﺘﻘﯾ ﺎﻣ مﻮﮭﻔﻣ وأ ةﺮﻜﻓ ﻦ
.
رﺎﮭظإو ﮫﺤﯿﺿﻮﺗ ﺪﻌﺑ تادﺮﻔﻣ ةﺪﻋ ﺢﺒﺼﯾ ﺮﺼﺘﺨﻣ وأ ةﺪﺣاو ةدﺮﻔﻣ يﺰﯿﻠﺠﻧﻹا ﺺﻨﻟا ﻲﻓ نﺎﻛ ﺎﻤﻓ ﺮﺼﺘﺨﻤﻟا ﻞﺜﻣ ،ﮫﯿﻠﻋ لاﺪﻟا مﻮﮭﻔﻤﻟا "
HPV "
ةرﺎﺒﻌﺑ ﻲﺑﺮﻌﻟا ﺺﻨﻟا ﻲﻓ ﻢﺟﺮﺘﯾ يﺬﻟا
"
سوﺮﯿﻓ
يﺮﺸﺒﻟا ﻲﻤﯿﻠﺤﻟا مرﻮﻟا "
ﻲﻓ تﺎﻤﻠﻛ ﻊﺑرأ ﻰﻟإ ﻲﻠﺻﻷا ﺺﻨﻟا ﻲﻓ ﺔﯿﻨﯿﺗﻻ فوﺮﺣ ﺔﺛﻼﺛ ﻦﻤﻓ ﺺﻨﻟا
ﮫﯿﻟإ ﻢﺟﺮﺘﻤﻟا .
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ﻰﻨﻌﻤﻟا كاردإ ﻞﺟأ ﻦﻣ ﮫﺗﺎﻧﻮﻜﻣ ﻚﯿﻜﻔﺗو ﻲﻠﺻﻷا ﺺﻨﻟا ﻞﯿﻠﺤﺗ ﻰﻠﻋ ﺔﻣﺎﻋ ﺔﻔﺼﺑ ﺔﻤﺟﺮﺘﻟا مﻮﻘﺗو ﺔﺤﺿاو ةرﻮﺼﺑ فﺪﮭﻟا ﺔﻐﻠﻟا ﻲﻓ يﻮﻐﻠﻟا ﻞﻜﺸﻟا ﻦﻣ دﺮﺠﻤﻟا ﻰﻨﻌﻤﻟا اﺬھ ﺔﻏﺎﯿﺻ ةدﺎﻋإو دﻮﺼﻘﻤﻟا .
ﻌﯾ ﺎﻣ كﺎﻨھ ﺲﯿﻟ نﻷ ﻲﺑﺮﻌﻟا ﺺﻨﻟا ﻲﻓ حﻮﺿﻮﻟا ةدﺎﯾز ﻰﻠﻋ ﺰﯿﻛﺮﺘﻟا ﺮﺴﻔﯾ ﺎﻣ اﺬھو ﺪﯿﺣﻮﺘﺑ فﺮ
ﺔﯿﻤﻟﺎﻌﻟا ﺔﺤﺼﻟا ﺔﻤﻈﻨﻣ ﻞﺜﻣ ﺪﯾﺪﻌﻟا تﻻوﺎﺤﻣ ﻢﻏر ﻢﺟﺮﺘﻤﻟا ﮫﻓﺮﻌﯾ يﺬﻟا ﻊﻗاﻮﻟا ﻲﻓ تﺎﺤﻠﻄﺼﻤﻟا مﻮﮭﻔﻤﻟا ﺲﻜﻌﺗ ﻻ تﺎﺤﻠﻄﺼﻤﻟا ﻦﻣ ﺪﯾﺪﻌﻟا نأ ﻻإ ﺪﺣﻮﻤﻟا ﻲﺒﻄﻟا ﻢﺠﻌﻤﻟا راﺪﺻإ ﻰﻟإ ﺖﻌﺳ ﻲﺘﻟا ﺔﯿﺑﺮﻌﻟا ﺔﻐﻠﻟا ﻲﻓ ﺔﻀﻣﺎﻏ ﻰﻘﺒﺗ وأ دﻮﺼﻘﻤﻟا .
ﻋﺎﺒﺘﻣ ﺔﯿﺑﺮﻌﻟاو ﺔﯾﺰﯿﻠﺠﻧﻹا ﻦﯿﺘﻐﻠﻟا نأ ﺎﻤﻛ ،بﻮﻠﺳﻷاو ﺔﯿﺒﯿﻛﺮﺘﻟا ﺔﯿﺣﺎﻨﻟا ﻦﻣ نﺎﺗﺪ
ﺺﻨﻟا وﺪﺒﯾ ﺚﯿﺤﺑ
،يﺰﯿﻠﺠﻧﻹا ﺺﻨﻟا لﺎﺣ ﻮھ ﺎﻤﻠﺜﻣ زﻮﻣﺮﻟاو تاﺮﺼﺘﺨﻤﻟا هدﻮﺴﯾ ﻻ اﺮﺴﻔﻣ ﻻﻮﻄﻣ ﺔﯿﺑﺮﻌﻟا ﺔﻐﻠﻟا ﻲﻓ ﺎﻤھﺆﻓﺎﻜﺗ ىﺪﻣ ﻮھ ﻢﮭﻤﻟﺎﻓ ،ﻦﯿﺼﻨﻟا ﻦﯿﺑ ﺆﻓﺎﻜﺘﻟا ﻰﻠﻋ مﻮﻘﺗ ﻲﺘﻟا ﺔﯾﺮﯿﺴﻔﺘﻟا ﺔﯾﺮﻈﻨﻟا ﻰﻟإ ادﺎﻨﺘﺳا ﻦﻜﻟو ﻨﻤﻟا ﺔﯾﺎﻐﻟا ﻖﯿﻘﺤﺗو ﻰﻨﻌﻤﻟا ﻲﻓ ﺔﯿﺣﺎﻨﻟا ﻦﻣ ﺎﻤﮭﻘﺑﺎﻄﺗ ﻦﻋ ﺮﻈﻨﻟا ﺾﻐﺑ ﻲﻠﺻﻷا ﺺﻨﻟا ﻦﻣ ةدﻮﺸ
ﺔﯾﻮﻐﻠﻟا .
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دﺮﺴﻣ
ﺔﯿﺒﻄﻟا تﺎﺤﻠﻄﺼﻤﻟا
يﺰﯿﻠﺠﻧا ﻲﺑﺮﻋ
Acupuncture Biopsy
Burkit’s lymphoma Cervical cancer Cervical epithelium Chemoradiation Chemotherapy (1) Chemotherapy (2) Chlamydia Trachomatis Cirrhosis
Clotting factor concentrates Cryptogenic hepatitis Cryotherapy
Cytology Deworming Epidemic
Epstein-Barr virus
ﺔﯿﻨﯿﺼﻟا ﺮﺑﻹﺎﺑ جﻼﻌﻟا
ﺔﯿﺣ ﺔﻨﯿﻋ ﺖﯿﻛﺮﺑ ﺔﻣﻮﻔﻤﻟ
ﻢﺣﺮﻟا ﻖﻨﻋ نﺎطﺮﺳ
ﻢﺣﺮﻟا ﻖﻨﻋ ةرﺎﮭظ
ﻞﻣﺎﻜﻟا ﻲﻋﺎﻌﺷﻹاو ﻲﺋﺎﯿﻤﯿﻜﻟا جﻼﻌﻟا
ﻲﺋﺎﯿﻤﯿﻜﻟا جﻼﻌﻟا
ﺔﯾﻮﯿﺤﻟا تادﺎﻀﻤﻟﺎﺑ جﻼﻌﻟا
ﺔﯾﺮﺜﺤﻟا ةﺮﺛﺪﺘﻤﻟا ﺎﯾﺮﯿﺘﻜﺑ
ﺪﺒﻜﻟا ﻊﻤﺸﺗ ضﺮﻣ
مﺪﻟا ﻲﻓ ةﺰﻛﺮﻤﻟا ﺮﺜﺨﺘﻟا ﻞﻣاﻮﻋ
ﺐﺒﺴﻟا لﻮﮭﺠﻣ ﺪﺒﻜﻟا بﺎﮭﺘﻟا
ﺪﯾﺮﺒﺘﻟﺎﺑ جﻼﻌﻟا
ﺔﯾﻮﻠﺨﻟا ﺔﺳارﺪﻟا
ناﺪﯾﺪﻟا ﻦﻣ ﺺﻠﺨﺘﻟا
ءﺎﺑو رﺎﺑ ﻦﯾﺎﺘﺸﺑا سوﺮﯿﻓ
106
Fibrosis Filariasis Genital warts
Helicobacter pylori bacterium Hemochromatosis
Herpes simplex virus Immune suppression Immunization Immunodeficiency Infection (1) Infection (2) Infection (3) Iron overload Jaundice
Kaposi sarcoma Lesion
Leukaemia Measles Metabolism Palliative care Pap test
ﺪﺒﻜﻟا ﻒﯿﻠﺗ ضﺮﻣ
تﺎﯿﻄﯿﺨﻟا ءاد
ﺔﯿﻠﺳﺎﻨﺘﻟا ﻞﯿﻟﺄﺜﻟا
ﺔﯿﺑاﻮﺒﻟا ﺔﯾﻮﻠﻤﻟا ةﺪﻌﻤﻟا ﺔﻣﻮﺛﺮﺟ
ﺔﯾﻮﻣﺪﻟا ﺔﻐﺒﺻﻷا ﺐﺳﺮﺗ ءاد
ﻂﯿﺴﺒﻟا ﺲﺑﺮﮭﻟا سوﺮﯿﻓ
ﺲﺒﺤﻟا ﻲﻋﺎﻨﻤﻟا
ﻦﯿﺼﺤﺘﻟا ﻲﻋﺎﻨﻤﻟا ﺲﺒﺤﻟا
ﺔﺑﺎﺻﻹا ﺪﻌﻣ ضﺮﻣ
ىوﺪﻌﻟا مﺪﻟا ﻲﻓ ﺪﺋاﺰﻟا ﺪﯾﺪﺤﻟا ﺐﺳﺮﺗ ضﺮﻣ
نﺎﻗﺮﯿﻟا يزﻮﺑﺎﻛ ﺔﻣﻮﻛرﺎﺳ
ﺔﻓآ مﺪﻟا نﺎطﺮﺳ
ﺔﺒﺼﺤﻟا دﺪﻐﻠﻟ ﻲﻠﺧاﺪﻟا نزاﻮﺘﻟا
ﺔﻔﻄﻠﻤﻟا ﺔﯾﺎﻋﺮﻟا
وﻻﻮﻜﯿﻧﺎﺑﺎﺑ رﺎﺒﺘﺧا
107
Pertussis
Radiofrequency ablation Rubella
Scarring Scar tissue Schistosmiases Sexual education Tetanus
Trachoma Vaccination (1) Vaccination (2) Visual inspection
ﻲﻜﯾﺪﻟا لﺎﻌﺴﻟا
ﻲﺋﺎﺑﺮﮭﻜﻟا ددﺮﺘﻟﺎﺑ مرﻮﻟا لﺎﺼﺌﺘﺳﻻا
ﺔﯿﻧﺎﻤﻟﻷا ﺔﺒﺼﺤﻟا
ا شﺪﺧ ﺪﻠﺠﻟ
ﺔﯿﻔﯿﻠﻟا ﺎﯾﻼﺨﻟا ﻦﻣ ﺞﯿﺴﻧ
ﺎﯿﺳرﺎﮭﻠﺒﻟا
ﺔﯿﺴﻨﺠﻟا ﺔﯿﺑﺮﺘﻟا
زاﺰﻜﻟا ﻲﺒﯿﺒﺤﻟا ﺪﻣﺮﻟا ضﺮﻣ
ﻢﯿﻌﻄﺘﻟا
ﺢﯿﻘﻠﺘﻟا ﺔﯾﺮﺼﺒﻟا ﺔﻨﯾﺎﻌﻤﻟا
ﻲﺒﻄﻟا ﺺﻨﻟا ﻲﻓ ﺎﮭﻣﻮﮭﻔﻣ ﺮﯿﻐﺘﯾ ﻲﺘﻟا ﺔﻣﺎﻌﻟا تﺎﺤﻠﻄﺼﻤﻟا
يﺰﯿﻠﺠﻧا
ﻲﺑﺮﻋ
Family Site Tissue
ﺔﻠﯿﺼﻓ
ﻢﺴﺠﻟا ﻲﻓ نﺎطﺮﺴﻟا ﻊﻗﻮﻣ
يﻮﻠﺨﻟا ﺞﯿﺴﻨﻟا
108
ﺮﺼﺘﺨﻤﻟا تا
ﺮﺼﺘﺨﻤﻟا
يﺰﯿﻠﺠﻧا ﻲﺑﺮﻋ
AIDS
CIN
DNA GAVI
HBsAg HBV HCC HCV HIV HPV RNA SIL
Acquired Immune Deficiency Syndrome
Cervical Intraepithelial Neoplasia
Deoxyribonucleic Acid
Global Alliance for Vaccine and Immunization
Hepatitis B Surface Antigen Hepatitis B Virus
Hepato Cellular Carcinoma Hepatitis C Virus
Human Immunodeficiency Virus Human Papillomavirus
Ribonucleic Acid
Squamous intra-epithelial lesions
زﺪﯾﻹا
ﻖﻨﻋ ةرﺎﮭظ ﻞﺧاد ﺔﺌﺷﺎﻨﻟا ماروﻷا
ﻢﺣﺮﻟا يوﻮﻨﻟا ﺾﻤﺤﻟا
تﺎﺣﺎﻘﻠﻟ ﻲﻤﻟﺎﻌﻟا ﻒﻟﺎﺤﺘﻟا
ﻦﯿﺼﺤﺘﻟاو
ﺪﺒﻜﻟا بﺎﮭﺘﻟﺎﺑ بﺎﺼﻣ
ﺪﺒﻜﻟا بﺎﮭﺘﻟا سوﺮﯿﻓ
"
B
"
ﺔﯾﺪﺒﻜﻟا ﺎﯾﻼﺨﻟا ﺔﻧﺎطﺮﺳ
ﺪﺒﻜﻟا بﺎﮭﺘﻟا سوﺮﯿﻓ
"
C
"
يﺮﺸﺒﻟا ﻲﻋﺎﻨﻤﻟا زﻮﻌﻟا سوﺮﯿﻓ
يﺮﺸﺒﻟا ﻲﻤﯿﻠﺤﻟا مرﻮﻟا سوﺮﯿﻓ
ﻲﺒﯾﺮﻟا يوﻮﻨﻟا ﺾﻤﺤﻟا
ا ةرﺎﮭظ ﻞﺧاد ﺔﯿﻔﺷﺮﺤﻟا تﺎﻓﻵ
ﻢﺣﺮﻟا ﻖﻨﻋ
109 STI UICC VIA
VLPs
Sexually Transmitted Infection International Union Against Cancer Visual Inspection with Acetic Acid
Virus-Like Particles
ﺎﯿﺴﻨﺟ ﺔﻟﻮﻘﻨﻤﻟا ضاﺮﻣﻷا
نﺎطﺮﺴﻟا ﺔﺤﻓﺎﻜﻤﻟ ﻲﻟوﺪﻟا دﺎﺤﺗﻻا
ﺾﻤﺣ ﺔﻄﺳاﻮﺑ ﺔﯾﺮﺼﺒﻟا ﺔﻨﯾﺎﻌﻤﻟا
ﻚﯿﺘﯿﺳﻷا سوﺮﯿﻔﻟا ﮫﺒﺸﺗ تﺎﻤﯿﺴﺟ
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ﻊﺟاﺮﻤﻟا ﺔﻤﺋﺎﻗ
-La traduction aujourd’hui, le modèle interprétatif, de Marianne Lederer, 1994.
-Medical translation step by step, learning by drafting, Vincent Montatt Resurreccio and Maria Gonzalez Davies, St Jerome Publishing 2007.
ﺐﺘﻜﻤﻟا ،ﺔﯿﺤﺼﻟا مﻮﻠﻌﻟا ﺐﯾﺮﻌﺗ ﺔﻜﺒﺷ ءﺎﻀﻋأ ،ﺔﯿﺒﻄﻟاو ﺔﯿﺤﺼﻟا مﻮﻠﻌﻟا ﺔﺒﻠﻄﻟ ﺢﻠﻄﺼﻤﻟا ﻢﻠﻋ
تﺎﺳارﺪﻟا ﺪﮭﻌﻣو ﻂﺳﻮﺘﻤﻟا قﺮﺸﻟ ﻲﻤﯿﻠﻗﻹا ﻲﺑﺮﻌﻟا ﺞﻣﺎﻧﺮﺒﻟا،ﺔﯿﺑﺮﻐﻤﻟا ﺔﻜﻠﻤﻤﻟﺎﺑ ﺔﯿﺤﻠﻄﺼﻤﻟا
،ﺔﯿﻤﻟﺎﻌﻟا ﺔﺤﺼﻟا ﺔﻤﻈﻨﻤﻟ 2005
.
-ﻲﻧوﺮﺘﻜﻟﻹا ﻊﻗﻮﻤﻟا ،يوﺎﻨﻤﻟا يزﻮﻓ ﺪﻤﺤﻣ د ،ﺎﺟذﻮﻤﻧ ﺐﻄﻟا ؟ﺔﯿﺑﺮﻌﻟا ﻢﻠﻌﻟا ﻢﻠﻜﺘﯾ ﻰﺘﻣ :
http://taiba-dz.forum .biz/t2582-topic ةرﺎﯾﺰﻟا ﺦﯾرﺎﺗ ،
: 18 \ 05
\ 2012
-يﺰﯿﻠﺠﻧا ،ﺪﯾﺪﺠﻟا ﻲﺒﻄﻟا ﻲﺘﺣ سﻮﻣﺎﻗ
-ﺑﺮﻋ د ،ﻲ . ﺔﺒﺘﻜﻣ ،ﺐﯿﻄﺨﻟا ﻖﯿﻔﺷ ﺪﻤﺣأو ﻲﺘﺣ ﻒﺳﻮﯾ
،نﺎﻨﺒﻟ 1998 .
،توﺮﯿﺑ ،قﺮﺸﻤﻟا راد ﻲﺑﺮﻋ،مﻼﻋﻷاو ﺔﻐﻠﻟا ﻲﻓ ﺪﺠﻨﻤﻟا -2005
-يﺰﯿﻠﺠﻧا ،ﻂﯿﺳﻮﻟا درﻮﻤﻟا
،ﻦﯿﯾﻼﻤﻠﻟ ﻢﻠﻌﻟا راد ،ﻲﺑﺮﻋ 2007
-يﺰﯿﻠﺠﻧا ،ﺪﺣﻮﻤﻟا ﻲﺒﻄﻟا ﻢﺠﻌﻤﻟا
-ﻲﺴﻧﺮﻓ ،ﺔﯿﻤﻟﺎﻌﻟا ﺔﺤﺼﻟا ﺔﻤﻈﻨﻣ ،ﻲﺑﺮﻋ 2009
ﻟا درﻮﻔﺴﻛا سﻮﻣﺎﻗ -يﺰﯿﻠﺠﻧا ،ﻂﯿﺤﻤ
ﺎﯿﻤﯾﺪﻛأ ،ﻲﺑﺮﻋ -2007
ﺔﻜﺒﺸﻟا ﻰﻠﻋ ﻊﺟاﺮﻤﻟا :
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com . medterms .
www
com . webster
-merriam .
www
int . who . emro . www
com . acronymfinder .
www
www.almaany.com
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