gms | German Medical Science

There is justifiable excitement about the recent introduction of prophylactic vaccines against human papillomavirus (HPV) types 16 (HPV-16) and HPV-18. Preventing these infections theoretically could avert the majority of cervical cancer cases worldwide. Numerous influential advocates are calling for universal vaccination of adolescent females. Given the promise of the vaccines, perhaps it is inevitable that vaccine introduction is proceeding before full consideration of how universal vaccination would affect existing, successful cervical cancer prevention programs. Determining the impact and cost effectiveness of the vaccines unavoidably will require time. Nevertheless, it is already clear that successful vaccination will dramatically reduce the effectiveness of screening methods including cytology, colposcopy, and HPV DNA testing. This is true because HPV16 causes the most evident screen-detectable precancerous abnormalities. Drawing from on simulations and actual post-vaccination trial data, this presentation will demonstrate the impact of HPV vaccination on screening. The obvious conclusion is that health planners considering the introduction of HPV vaccination must consider all aspects of cervical cancer prevention together, with full consideration of population effectiveness data. In particular, broad population immunity against HPV16 might even force a reconsideration of the utility of cytology and colposcopy, and accelerate the use of type-specific HPV testing or other molecular markers.