Clinical Review

Developing role of HPV in cervical cancer prevention

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4781 (Published 07 August 2013) Cite this as: BMJ 2013;347:f4781

This article has a correction. Please see:

  1. Henry C Kitchener, professor of gynaecological oncology1,
  2. Karin Denton, consultant cytopathologist2,
  3. Kate Soldan, scientist-epidemiologist3,
  4. Emma J Crosbie, senior lecturer and honorary consultant in gynaecological oncology 1
  1. 1Institute of Cancer Sciences, University of Manchester, St Mary’s Hospital, Manchester M13 9WL, UK
  2. 2South West Quality Assurance reference centre, Public Health England, Bristol, UK
  3. 3Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
  1. Correspondence to: H Kitchener Henry.kitchener{at}manchester.ac.uk
  • Accepted 24 July 2013

Summary points

  • Prophylactic vaccination against human papillomavirus (HPV) types 16 and 18 is predicted to further reduce deaths from cervical cancer, among a screened population

  • Vaccinated women should participate in cervical screening

  • Vaccination will also reduce referrals to colposcopy and the number of women who require treatment for high grade, cervical intraepithelial neoplasia

  • Vaccination against HPV types 6 and 11 will result in a decline in genital warts

  • HPV testing in the screening programme is now routinely used in England to triage women with low grade cytological abnormalities for colposcopy referral, and similarly for test of cure after treatment

  • HPV negative women are at very low risk and can avoid the need for repeated annual recall, and screening intervals could be extended

  • Secondary prevention based on HPV testing with a simple treatment algorithm, if feasible in developing countries, might prevent many deaths

  • If primary prevention through vaccination were implemented in developing countries, millions of deaths from cervical cancer could be prevented over the next 50 years

Since the Cervical Screening Programme was introduced in England, the incidence of cervical cancer has fallen by 44% and number of deaths from the disease by 70% (fig 1). This effect has also been seen in other countries.1 2 The discovery of human papillomavirus (HPV) DNA in cervical cancer and in subsequent molecular biology and epidemiological studies shows that persistent cervical infection with “high risk” HPV types is a necessary cause of cervical cancer. This finding has led to two major developments in cervical cancer control: immunisation as a means of primary prevention and HPV testing in cervical screening, which is poised to replace cytology as the primary screening modality. This article reviews the evidence base for evolving from exfoliative cytology alone to a dual approach of HPV vaccination and HPV based cervical screening. …

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