Commentary: Health inequity could increase in poor countries if universal HPV vaccination is not adoptedBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39280.457350.BE (Published 23 August 2007) Cite this as: BMJ 2007;335:378
- Eduardo L Franco, professor
- Departments of Oncology and Epidemiology, McGill University, Montreal, QC, Canada H2W 1S6
Resource rich countries such as the United Kingdom, which provide universal access to health care, already commit substantial resources to screening programmes for cervical cancer.1 It is hard to propose changes to the status quo when cervical cancer control has been so successful.2 Yet, no policymaker can ignore the pressure from the public, health providers, and drug companies calling for widescale adoption of vaccination for human papillomavirus (HPV). The danger is that women may “trade 80% protection from screening for 17% protection from vaccination.”1 3 Will the UK allow this to happen? I think not. As Raffle points out, the UK should ensure that primary prevention by HPV vaccination is integrated with secondary prevention via screening.1
It is likely that testing for DNA of oncogenic HPV types, which can be performed on the same sample as that used for cytology, will provide a way around the low sensitivity of Papanicolaou cytology in detecting cervical precancer.4 The downside of HPV DNA testing, however, is that it has a slightly higher rate of false positivity than cytology, because it detects virus in cervical cells before they show morphological abnormalities.
A more logical choice, therefore, is cytological triage of women positive for HPV DNA, which will detect those who should undergo colposcopy and biopsy …