Is Cervix Cancer a Disappearing Disease? Impact of HPV Vaccination in Developed Countries
Human papillomavirus (HPV) vaccination of preadolescent girls has been found to be both effective and cost-effective and has now been introduced in many developed countries. Because rates of cervical cancer peak in older women, vaccination is expected to take some years to substantially reduce the overall rates of invasive cervical cancer, but in countries with high rates of vaccination coverage, cancer rates in younger women are expected to drop more rapidly. In countries that continue to screen women starting in their early twenties, rates of high-grade cervical intraepithelial neoplasia (CIN) should be reduced within a few years. Because of an expected reduction in women requiring treatment for CIN, HPV vaccination has the potential to reduce rates of preterm delivery, premature rupture of the membranes, and low birth weight in some settings, although the evidence on the association between treatment for CIN and obstetric complications is somewhat conflicting. In general terms, the timing and extent of the impact of vaccination on organized screening programs will depend on factors specific to each country, including coverage rates achieved in vaccination programs, the age range of catch-up vaccination, and the age of starting cervical screening. Cervical screening will need to continue for the foreseeable future since older cohorts are not vaccinated. Preliminary findings suggest that some form of cervical screening will continue to be cost-effective even in cohorts that are now being vaccinated as preadolescents. However, optimizing screening in the long term is likely to depend on an eventual transition to primary HPV screening at intervals of 5–6 years or even longer.
KeywordsCervical Cancer Cervical Intraepithelial Neoplasia Invasive Cervical Cancer Cervical Screening Organize Screening Program
KC declares that she is co-PI of a new trial of primary HPV screening in Australia (‘Compass’) which has received a funding contribution from Roche Molecular Systems, CA, USA.
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