Analysis

Challenges of implementing human papillomavirus (HPV) vaccination policy

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39273.458322.BE (Published 23 August 2007) Cite this as: BMJ 2007;335:375
  1. Angela E Raffle, consultant in public health
  1. Bristol Primary Care Trust, King Square, Bristol BS2 8EE
  1. angela.raffle{at}bristolpct.nhs.uk
  • Accepted 4 July 2007

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

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, and health service staff is essential. The challenge for the UK and other countries with established cervical screening programmes is to switch to new and affordable programmes of cancer control that will do more good and less harm than existing ones.

Development of HPV vaccines

The association between cervical cancer and HPV was discovered in the 1970s, HPV type 16 DNA was identified in biopsy samples in the early 1980s, and by 2003 the classification of the seven most prevalent HPV types that cause 87% of cervical cancers was described.4 The creation of preventive vaccines soon followed. At present no vaccines can treat existing HPV infection.

Two vaccines have been developed so far and …

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