Prevention of Cervical Cancer: Era of HPV Testing and Vaccination

Abstract

The incidence and mortality of cervical cancer in young women of reproductive ages have recently increased, which is a serious issue worldwide. This chapter will focus on the prevention of cervical cancer with HPV testing and vaccination. It is recognized that strategies for preventing cervical cancer consist of two major steps: preventing infection of oncogenic human papillomavirus (HPV)-16 and HPV-18 by HPV vaccination and secondary prevention by screening using HPV testing and/or cytology. Current cervical cancer screening strategies using cytology combined with HPV testing have been successfully introduced, with shifting from cytology alone to cytology plus HPV cotesting and now to a new paradigm in which HPV testing alone may become a primary screening tool. HPV vaccination is a “primary prevention” tool, and both the bivalent and quadrivalent HPV vaccines have excellent safety and efficacy profiles. Recently, a 9-valent vaccine, targeted against HPV-6, HPV-11, HPV-16, HPV-18, HPV-31, HPV-33, HPV-45, HPV-52, and HPV-58, has been developed, which may possibly protect against over 80% of invasive cervical cancers. Further evidence on the 9-valent HPV vaccine should be accumulated worldwide, and its application is expected as a new strategy. Finally, the WHO recognizes the prevention of cervical cancer and other HPV-related diseases as global public health problems and strongly recommends the HPV vaccination programs. Both HPV vaccination and cancer screening tests are indispensable for cervical cancer prevention. The complete eradication of this malignant disease in the world will be realized in the near future by the further development and widespread application of these two strategies.