HPV vaccination and improved screening via molecular methods: new strategies in cervical cancer prevention
Eduardo Franco
McGill University, Montreal, Canada
Cervical cancer affects about half million women annually, worldwide. More than half of them die prematurely as a consequence of their disease. Pap cytology screening programmes, either organised or opportunistic, have had a substantial impact in reducing cervical cancer incidence and mortality in Western Europe and North America, where enough resources are devoted to ensure that screening is carried out with high coverage, has adequate quality, and that lesions detected by the Pap test are treated on a timely basis to prevent the onset of invasive cervical cancer. Unfortunately, the same cannot be said of its impact in other regions, where Pap screening has not worked as expected despite being broadly adopted or has only benefited a privileged, small segment of society.
The relatively recent understanding of the causal connection between infection with certain genotypes (so-called high-risk, or oncogenic types) of human papillomavirus (HPV) and cervical cancer has paved the way for new approaches in cervical cancer prevention. Persistent infection with high-risk HPVs (HR-HPV) is a necessary precursor in cervical carcinogenesis. Preventing acquisition of such infections via vaccination and detecting the precancerous lesions that originate from them via screening have become today’s main prevention fronts against cervical cancer. Prophylactic vaccination against HPV types 16 and 18, the most important HR-HPVs, and screening based on HR-HPV DNA detection have arrived to shift the opportunity for disease prevention to the upstream steps of the carcinogenetic process.
Despite the justifiable optimism, the new tools of vaccination and screening are yet far from being perfected and their deployment represents a costly undertaking still beyond reach in populations that need them the most. Moreover, the shift in cervical cancer prevention paradigms has met with resistance and has prompted a broad discussion by all stakeholders and professional groups involved in cancer control.
Declaration of competing interest for Eduardo Franco: Eduardo Franco speaker has served as occasional consultant or advisory board member to pharmaceutical companies that produce HPV vaccines and to biotechnology companies involved in cervical cancer screening.
