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PERSPECTIVES
F.Xavier Bosch, Claudia Robles, Mireia Daz, Marc Arbyn, Iacopo Baussano, Christine Clavel, Guglielmo Ronco, Joakim Dillner, Matti Lehtinen, Karl-UlrichPetry, Mario Poljak, Susanne K.Kjaer, Chris J.L.M.Meijer, Suzanne M.Garland, Jorge Salmern, Xavier Castellsagu, Laia Bruni, Silviade Sanjos and Jack Cuzick
Abstract | Human papillomavirus (HPV)-related screening technologies and HPV vaccination offer enormous potential for cancer prevention, notably prevention of cervical cancer. The effectiveness of these approaches is, however, suboptimal owing to limited implementation of screening programmes and restricted indications for HPV vaccination. Trials of HPV vaccination in women aged up to 55years have shown almost 90% protection from cervical precancer caused by HPV16/18 among HPV16/18-DNA-negative women. We propose extending routine vaccination programmes to women of up to 30years of age (and to the 4550year age groups in some settings), paired with at least one HPVscreening test at age 30years or older. Expanding the indications for HPV vaccination and much greater use of HPV testing in screening programmes has the potential to accelerate the decline in cervical cancer incidence. Such a combined protocol would represent an attractive approach for many health-care systems, inparticular, countries in Central and Eastern Europe, Latin America, Asia, and some more-developed parts of Africa. The role of vaccination in women aged >30years and the optimal number of HPVscreening tests required in vaccinated women remain important research issues. Costeffectiveness models will help determine the optimal combination of HPV vaccination and screening in public health programmes, and to estimate the effects of such approaches in differentpopulations.
females in 41 (22%) of 184 countries11
mainly those in developing regions, although it was once the most-common cancer in women from developed regions12. The disease has a relatively early age at onset and ranks among the three most-frequent cancers in women aged <45years in 82% of countries11.
The cervical cancer incidence has been greatly reduced in the populations of many developed countries that have made substantial investments to provide wide screening coverage and the associated infrastructure required to diagnose and treat precursor lesions in women with a positive screen13,14. These programmes, however, are costly and are not devoidof negative adverse effects related to overdiagnosis and overtreatment of cervical neoplasms that have a very low potential for progression to cancer1518.
Surgical treatment of screen-detected cervical lesions in young women...