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The impact of human papillomavirus vaccination on cervical cancer prevention efforts

      Abstract

      Objectives

      To review concepts, information, obstacles, and approaches to cervical cancer screening and prevention as vaccination against human papillomavirus (HPV) types 16 and 18 is adopted.

      Methods

      Expert forum, conducted September 12–13, 2008, hosted by the Society of Gynecologic Oncologists, including 56 experts in cervical cancer and titled Future Strategies of Cervical Cancer Prevention: What Do We Need to Do Now to Prepare?

      Results

      The current approach to cervical cancer screening in the U.S. is limited by its opportunistic nature. If given to women before exposure, a vaccine against HPV 16,18 can decrease cervical cancer risk by up to 70%. The impact on abnormal cytology and cervical intraepithelial neoplasia (CIN) will be less but still substantial. As the prevalence of high-grade CIN falls, fewer women with positive screening tests will have truly preinvasive disease. To minimize harm from false positive tests in women who are at low risk for cancer because of early vaccination, later initiation of and longer intervals between screenings are ideal. However, the vaccine is less effective when administered after first intercourse, and delivering and documenting HPV vaccination to girls at optimal ages may prove difficult.

      Conclusions

      Until population-based data on the performance of cytology, HPV testing, and alternate screening or triage interventions become available, modifying current screening guidelines is premature. Current recommendations to initiate screening as late as age 21 and to screen less often than annually are appropriate for young women known to have been vaccinated before first intercourse.

      Keywords

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      References

        • The Future II Study Group
        Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trials.
        Lancet. 2007; 369: 1861-1868
        • Paavonen J.
        • Jenkins D.
        • Bosch F.X.
        • Naud P.
        • Salmeron J.
        • Wheeler C.M.
        • et al.
        Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomized controlled trial.
        Lancet. 2007; 369: 2161-2170
        • Jemal A.
        • Siegel R.
        • Ward E.
        • Hao Y.
        • Xu J.
        • et al.
        Cancer statistics, 2008.
        CA Cancer J. Clin. 2008; 58: 71-96
        • Saslow D.
        • Runowicz C.D.
        • Solomon D.
        • Moscicki A.B.
        • SMight R.A.
        • Eyre J.H.
        • Cohen C.
        American Cancer Society Guideline for the early detection of cervical neoplasia and cancer.
        CA Cancer J. Clin. 2002; 52: 342-362
        • American College of Obstetricians and Gynecologists
        Routine cancer screening. ACOG Committee Opinion No. 356.
        Obstet. Gynecol. 2006; 108: 1611-1613
        • Wright T.C.
        • Massad L.S.
        • Dunton C.J.
        • Spitzer M.
        • Wilkinson E.J.
        • Solomon D for the 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference
        2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests.
        J. Lower Genit. Tract. Dis. 2007; 11: 201-222
        • Saslow D.
        • Castle P.E.
        • Cox J.T.
        • Davey D.D.
        • Einstein M.H.
        • Ferris D.G.
        • et al.
        American Cancer Society guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors.
        CA Cancer J. Clin. 2007; 57: 7-28
        • Sirovich B.E.
        • Welch H.G.
        The frequency of Pap smear screening in the United States.
        J. Gen. Intern. Med. 2004; 19: 243-250
        • Sawaya G.F.
        • McConnell J.
        • Kulasingam S.L.
        • Lawson H.W.
        • Kerlikowske K.
        • et al.
        Risk of cervical cancer associated with extending the interval between cervical-cancer screenings.
        N. Engl. J. Med. 2003; 349: 1501-1509
        • Quinn M.
        • Babb P.
        • Jone J.
        • Allen E.
        Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics.
        BMJ. 1999; 318: 904-908
        • Stokes-Lampard H.
        • Wilson S.
        • Waddell C.
        • Ryan A.
        • Holder R.
        • Kehoe S.
        Vaginal vault smears after hysterectomy for reasons other than malignancy: a systematic review of the literature.
        BJOG. 2006; 113: 1354-1365
        • Meissner H.I.
        • Tiro J.A.
        • Haggstrom D.
        • Lu-Yao G.
        • Breen N.
        Does patient health and hysterectomy status influence cervical cancer screening in older women?.
        J. Gen. Intern. Med. 2008; 23: 1822-1828
        • Ferenczy A.
        • Choukroun D.
        • Arseneau J.
        Loop electrosurgical excision procedure for squamous intraepithelial lesions of the cervix: advantages and potential pitfalls.
        Obstet. Gynecol. 1996; 87: 332-337
        • Arbyn M.
        • Kyrgiou M.
        • Simoens C.
        • Ralfu A.O.
        • Koliopoulos G.
        • Martin-Hirsch P.
        • et al.
        Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis.
        BMJ. 2008; 337: a1284
        • Spence A.R.
        • Goggin P.
        • Franco E.L.
        Process of care failures in invasive cervical cancer: systematic review and meta-analysis.
        Prev. Med. 2007; 45: 93-106
        • Frable W.J.
        Error reduction and risk management in cytopathology.
        Semin. Diagn. Pathol. 2007; 24: 77-88
        • Castle P.E.
        Is monitoring of human papillomavirus infection for viral persistence ready for use in cervical cancer screening?.
        Am. J. Epidemiol. 2008; 168: 138-144
        • Waller J.
        • Marlow L.A.
        • Wardle J.
        The association between knowledge of HPV and feelings of stigma, shame, and anxiety.
        Sex Transm. Infect. 2007; 83: 155-159
        • Boronow R.C.
        Death of the Papanicolaou smear? A tale of three reasons.
        Am. J. Obstet. Gynecol. 1998; 179: 391-396
        • Gage J.C.
        • Hanson V.W.
        • Abbey K.
        • Dippery S.
        • Gardner S.
        • Kubota J.
        • et al.
        Number of cervical biopsies and sensitivity of colposcopy.
        Obstet. Gynecol. 2006; 108: 264-272
        • Kim J.J.
        • Brisson M.
        • Edmunds W.J.
        • Goldie S.J.
        Vaccine. 2008 Aug 19; 26: K76-K86
      1. Vaccination coverage among adolescents aged 13–17 years — United States, 2007.
        Morb. Mort. Wkly Rep. 2008; 57: 1100-1103
        • Huh W.K.
        • and the Quadrivalent HPV Vaccine Phase IIB/III Investigators
        Impact of quadrivalent human papillomavirus (HPV) L1 virus-like particle vaccine on the incidence of abnormal pap tests and cervical procedures.
        Gynecol. Oncol. 2008; 108: S10
        • Insinga R.P.
        • Liaw K.L.
        • Johnson L.G.
        • Madeleine M.M.
        A systematic review of the prevalence and attribution of human papillomavirus types among cervical, vaginal, and vulvar precancers and cancers in the United States.
        Cancer Epidemiol. Biomarkers Prev. 2008; 17: 1611-1622
        • Klug S.J.
        • Hukelmann M.
        • Hollwitz B.
        • Duzenli N.
        • Schopp B.
        • et al.
        Prevalence of human papillomavirus types in women screened by cytology in Germany.
        J. Med. Virology. 2007; 79: 616-625
        • Kovacic M.B.
        • Castle P.E.
        • Herrero R.
        • Schiffman M.
        • Sherman M.E.
        • et al.
        Relationships of human papillomavirus type, qualitative viral load, and age with cytologic abnormality.
        Cancer Res. 2006; 66: 10112-10119
        • Sargent A.
        • Bailey A.
        • Almonte M.
        • Turner A.
        • Thomson C.
        • et al.
        • for the ARTISTIC Study Group
        Prevalence of type-specific infection by age and grade of cervical cytology: data from the ARTISTIC trial.
        Br. J. Cancer. 2008; 98: 1704-1709
        • Kjaer S.K.
        • Breugelmans G.
        • Munk C.
        • Junge J.
        • Watson M.
        • et al.
        Population-based prevalence, type- and age-specific distribution of HPV in women before introduction of an HPV-vaccination program in Denmark.
        Int. J. Cancer. 2008; 123: 1864-1870
        • Wheeler C.M.
        • Hunt W.C.
        • Schiffman M.
        • Castle PE for the Atypical Squamous Cells of Undetermined Significance/Low-grade Squamous Intraepithelial Lesions Triage Study Group
        Human papillomavirus genotypes and the cumulative 2-year risk of cervical precancer.
        J. Infect. Dis. 2006; 194: 1291-1299
        • Briolat J.
        • Dalstein V.
        • Saunier M.
        • Joseph K.
        • Caudroy S.
        • et al.
        HPV prevalence, viral load, and physical state of HPV-16 in cervical smears of patients with different grades of CIN.
        Int. J. Cancer. 2007; 121: 2198-2204
        • Wentzensen N.
        • Schiffman M.
        • Dunn S.T.
        • Zuna R.E.
        • Walker J.
        • et al.
        Grading the severity of cervical neoplasia based on combined histopathology, cytopathology, and HPV genotype distribution among 1,700 women referred to colposcopy in Oklahoma.
        Int. J. Cancer. 2009; 124: 964-969
        • Gravitt P.E.
        • van Doorn L.J.
        • Quint W.
        • Schiffman M.
        • Hildesheim A.
        • et al.
        Human papillomavirus (HPV) genotyping using paired exfoliated cervicovaginal cells and paraffin-embedded tissues to highlight difficulties in attributing HPV types to specific lesions.
        J. Clin. Microbiol. 2007; 45: 3245-3250
        • Sherman M.E.
        • Wang S.S.
        • Wheeler C.M.
        • Rich L.
        • Gravitt P.E.
        • et al.
        Determinants of human papillomavirus load among women with histological cervical intraepithelial neoplasia 3: dominant impact of surrounding low-grade lesions.
        Cancer Epidemiol. Biomarkers Prev. 2003; 12: 1038-1044
        • Schifman M.
        Integration of human papillomavirus vaccination, cytology, and human papillomavirus testing.
        Cancer. 2007; 111: 145-153
        • Kiviat N.B.
        • Hawes S.E.
        • Feng Q.
        Screening for cervical cancer in the era of the HPV vaccine — the urgent need for both new screening guidelines and new biomarkers.
        JNCI. 2008; 100: 308-320
        • Khan M.J.
        • Castle P.E.
        • Lorincz A.T.
        • Wacholder S.
        • Sherman M.
        • Scott D.R.
        • et al.
        The elevated 10-year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice.
        J. Natl. Cancer Inst. 2005; 97: 1072-1079
        • Markowitz L.E.
        • Dunne E.F.
        • Saraiya M.
        • Lawson H.W.
        • Chesson H.
        • Unger ER the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices
        Quadrivalent human papillomavirus vaccine: recommendations of the advisory Committee on Immunization Practices.
        MMWR Recomm. Rep. 2007; 56: 1-24
        • Kim J.J.
        • Goldie S.J.
        Health and economic implications of HPV vaccination in the United States.
        N. Engl. J. Med. 2008; 359: 821-832
      2. Tugetman J, Reimers LL, Ginsberg MS, Sandesara N, Kuo DY, Einstein MH. Sociodemographic and HPV risk factor assessment of early-adopting users of the HPV vaccine in the late catch-up population (ages 19–26) in an ethnically diverse, urban population. Presented at the 40th Annual SGO meeting San Antonio, TX 2009.

        • Cooper C.P.
        • Saraiya M.
        • McLean T.A.
        • Hannan J.
        • Liesmann J.M.
        • et al.
        Pap test intervals used by physicians serving low-income women through the National Breast and Cervical Cancer Early Detection Program.
        J. Women's Health. 2005; 14: 670-678
        • Ubel P.A.
        • Jepson C.
        • Baron J.
        • Hershey J.C.
        • Asch D.A.
        The influence of cost-effectiveness information on physicians' cancer screening recommendations.
        Social Sci. Med. 2003; 56: 1727-1736
        • Sirovich B.E.
        • Woloshin S.
        • Schwartz L.M.
        Screening for cervical cancer: will women accept less?.
        Am. J. Med. 2005; 118: 151-158