Recently, the news of “the first trial of free cervical cancer vaccination in Zhungeer, Inner Mongolia” has made a big splash in various news headlines. Many people are calling for this kind of measure to be promoted as soon as possible, so as to provide more protection for women’s health. However, the free vaccination in Inner Mongolia uses bivalent vaccine, which makes many people who know about HPV vaccine and cervical cancer complain: these nine valent vaccines have come out. Is it a bit out of date to make bivalent vaccine now? However, the price of this vaccine can not be determined only by the price. The bivalent vaccine targets HPV-16 and HPV-18, but they are the “most high-risk” and most likely to cause two subtypes of cervical cancer, so the priority of response should also be ranked at the top. Recently, a new study carried out by many scientists in Africa also shows that compared with other subtypes of HPV, HPV-18 causes the worst and most dangerous prognosis of cervical cancer, and even compared with HPV-16, which belongs to the same high-risk subtype, the risk of death of patients with cervical cancer caused by HPV-18 is much higher! < p > < p > this study analyzed 212 patients in Uganda, an African country. Scientists conducted a comprehensive genome analysis of tumor samples. Therefore, the study not only found that the prognosis of cervical cancer caused by HPV-18 was worse, but also analyzed the characteristics of HPV-induced cancer gene changes. The paper was published in Nature Genetics. Due to economic backwardness, poor medical conditions, weak awareness of cervical cancer screening and other reasons, African countries are generally the high incidence areas of cervical cancer. Among the 20 countries with the highest mortality rate of cervical cancer in the world, 19 are located in sub Saharan Africa. < p > < p > to achieve the goal of “eliminating cervical cancer”, it is necessary to have a deep understanding of the characteristics of cervical cancer and HPV infection in African countries, so as to formulate targeted diagnosis and treatment strategies such as vaccination and screening. This research, led by Canadian scientists, is also the first genome level study on cervical cancer patients in Africa. From the perspective of patient characteristics, HIV infection is a major feature of African patients, and the HIV positive rate is more than 60%. However, only a few genes such as PIK3CA are expressed in HIV positive / negative patients, and the overall impact is not significant. It seems that to analyze the characteristics of patients, or to focus on HPV. The results of sequencing showed that there were significant differences in gene expression between HPV A9 and A7 subgroups of HPV-16 and HPV-18, which may be related to the epigenetic differences caused by different subtypes of HPV, especially methylation differences. Different expression of < / P > < p > gene will lead to different biological behavior of tumor, which is reflected in patients, that is, the characteristics of disease and prognosis of patients are different. The data showed that the prognosis of cervical cancer caused by A7 subgroup of HPV-18 was significantly worse, and the death risk of patients was significantly increased (HR 1.83). < p > < p > even considering the multiple factors such as disease stage, HIV infection and histological type, HPV-18 has a significant impact on the prognosis of patients (HR 1.75). This is similar to previous studies in Europe and the United States: HPV-16 infection causes more cervical cancer, but HPV-18 causes more cancer. Further analysis by the research team showed that the expression of genes related to epithelial mesenchymal transition (EMT) was significantly up-regulated in HPV-18 infected cervical cancer samples, which means that hpv-18-induced cervical cancer may have a lower degree of differentiation, which is contrary to the role of HPV-16. In addition, HPV-18 may affect the epigenetics in cells through the integration of its own DNA and patient’s DNA, resulting in changes in the expression of oncogenes such as erbB2 and the emergence of endogenous retroviral sequences (ERVs), which may be related to the higher malignancy of cancer. The fact that HPV-18 is more dangerous has been hammered again, so it is necessary to promote HPV vaccine for high-risk subtypes. From the perspective of public health, the promotion of bivalent vaccine is the most cost-effective measure for China, a populous country. < / P > < p > although the odd cake said before that a single dose of HPV vaccine might be enough, it was a study released during the outbreak. Now life is almost back to normal. All female compatriots who have relevant plans should arrange early and vaccinate according to the plan. Less high-risk HPV, more health, right?