Background: Annually, HPV-related cancers represent nearly 10% of all new cancers in females worldwide with ~14% in the developing-world regions. We have safe, immunogenic, efficacious prophylactic HPV vaccines which prevent vaccine- related HPV infection and disease. Yet despite licensure of HPV vaccines in over 130 countries, with 64 countries having such vaccines in their National immunisation programmes, the actual percentage of eligible females vaccinated in the world is less than 2%.
Objectives: In countries where vaccine coverage is high, already there is seen a reduction in vaccine- related HPV genoprevalence, as well as short incubation diseases (genital warts, cervical lesions). Consequently, the positive predictive value (PPV) of cervical cytology screening, when comprehensive and well quality controlled, in finding cervical lesions becomes unacceptably low. Therefore, more sensitive methods, with greater PPVs, such as HPV DNA are being considered for primary screening.
Methods & Results: Using Australia as an example, integration of screening and vaccination will be examined. Australia has had public health government funded school-based program for HPV vaccination for young girls since 2007 and boys since 2013. There was a catch up program to 26 years of age for females until the end of 2009. With good vaccine acceptance and high coverage, already vaccine-related HPV genoprevalence has declined markedly in vaccine eligible age groups, together with evidence of herd protection and cross protection of phylogenetically related types. This has translated into marked reductions in cervical lesions, as well as genital warts. Consequently, a comprehensive review of the cervical cytology screening program for females 18 to 69 years, every two years has been made under the “Renewal program,” with adoption of HPV DNA primary screening as of May 2017 for women commencing at 25 years of age with 5 yearly intervals.
Conclusion: Australia has embraced prophylactic HPV vaccination, with a gender neutral approach. In addition, with the impact of vaccination reducing vaccine-related HPV disease, primary screening is to change shortly to HPV DNA, commencing at 25 years age.