BMJ  2007;335:375-377 (25 August), doi:10.1136/bmj.39273.458322.BE

Analysis

Challenges of implementing human papillomavirus (HPV) vaccination policy

Bristol Primary Care Trust, King Square, Bristol BS2 8EE

Angela E Raffle argues that in countries with established cervical screening programmes, HPV vaccination of pre-adolescent girls could bring additional benefit at an affordable cost, but careful planning, adequate education, and integral evaluation will be needed

The first 150 words of the full text of this article appear below.

Summary points High quality cervical screening reduces deaths from cervical cancer by around 80% Vaccines against HPV should improve prevention of cervical cancer in countries without screening Vaccination is less effective than high quality screening in females over 16 years Vaccination for pre-adolescent girls, with proper education and planning, could improve overall benefit compared with existing screening

In affluent countries, cervical screening programmes are reducing deaths from cervical cancer, but screening is labour intensive and needs meticulous attention to quality to ensure benefits exceed harms.^{1 2 3} Vaccines against human papillomavirus (HPV) provide a new approach to preventing cervical cancer, particularly in countries with a high incidence of the disease and no or poorly developed screening programmes. In the United Kingdom, universal HPV vaccination of girls aged 12-13 will be introduced subject to an independent review of its costs and benefits. Implementation will be complex, and careful planning and education for the public, participants, . . . [Full text of this article]

Development of HPV vaccines

Public policy on preventing cervical cancer

What is the evidence so far?

Vaccine studies
Attitudes to vaccination
Modelling of impact on HPV prevalence and cancer incidence

Things we still don't know

Things we do know

Cost implications of universal vaccination

Conclusion

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• Brabin, L., Roberts, S. A, Stretch, R., Baxter, D., Chambers, G., Kitchener, H., McCann, R. (2008). Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study. BMJ 336: 1056-1058 [Abstract] [Full text]  
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