Journal
NATURE REVIEWS CLINICAL ONCOLOGY
Volume 13, Issue 2, Pages 119-132Publisher
NATURE PORTFOLIO
DOI: 10.1038/nrclinonc.2015.146
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Funding
- European Union Seventh Framework Programme [603019]
- Spanish Ministry of Economy and Competitiveness via the Instituto de Salud Carlos III [RD12/0036/0056]
- Government of Catalonia via the Agencia de Gestio d'Ajuts Universitaris i de Recerca (Agency for Management of University and Research Grant) [2014SGR1077, 2014SGR2016]
- Lilly Foundation (Premio de Investigacion Biomedica Preclinica)
- National Institute of Public Health and the Environment (Bilthoven, Netherlands)
- German Guideline Program in Oncology (German Cancer Aid project) [110163]
- Belgian Health Care Knowledge Centre (Brussels, Belgium)
- Bill and Melinda Gates Foundation [OPP1053353]
- Institut National du Cancer
- Zorgonderzoek Nederland-Medische Wetenschappen (ZON-MW)
- Dutch Cancer Society
- Cancer Research UK [C569/A16891]
- Cancer Research UK [16891] Funding Source: researchfish
- Bill and Melinda Gates Foundation [OPP1053353] Funding Source: Bill and Melinda Gates Foundation
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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 55 years 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 30 years of age (and to the 45-50-year age groups in some settings), paired with at least one HPV-screening test at age 30 years 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, in particular, countries in Central and Eastern Europe, Latin America, Asia, and some more-developed parts of Africa. The role of vaccination in women aged > 30 years and the optimal number of HPV-screening tests required in vaccinated women remain important research issues. Cost-effectiveness 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 different populations.
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