HPV Elimination of Cervical Cancer: The Novel Options in Vaccination and Screening

Abstract

The recognition that infection with certain human papillomavirus (HPV) types is a necessary cause of cervical cancer has opened new fronts for the prevention of this disease. Primary prevention is now possible via immunization and secondary prevention has gained impetus with the availability of HPV DNA testing. Although universal vaccination of teenagers and young women is a desirable policy, even with high uptake a substantial reduction in the burden of cervical cancer is unlikely for at least 10-15 years. To achieve cost-effective reductions, screening and immunization must be considered as integrated approaches. Several novel options are possible. If the nonavalent vaccine proves to be effective, a screen and vaccine strategy in older women is attractive, and raises the possibility of virtually eliminating cervix cancer in 5-10 years. New approaches for triage following primary HPV-based screening are also being developed and promise to substantially reduce referrals for non-progressive infections. These include HPV typing, p16 and methylation of viral and human genes. Lastly, the use of self sampling is likely to increase in vaccinated women with less frequent HPV-based tests. New collection devices and transport media will be needed to facilitate this.