Session date: 16/June/ 2016
Session number: SS 02
Screening and vaccination interaction: the current perspective
How to best combine vaccination and screening to optimize cervical cancer prevention: the HPV faster consortium
In spite of the availability of cervical cytology and HPV screening technologies and more recently, of prophylactic HPV vaccines, cervical cancer remains amongst the three most common cancers in women and consistently the second most common in developing countries. In Europe, some 50,000 new cases of cervical cancer occur yearly with a 40 to 60 % mortality rate and great social inequality. Half of these cases occur in the western countries in Europe where screening activities have been in place for decades.
HPV screening has proven to be able to clear prevalent lesions / women at high risk with sensitivities greater than 90% and technology is available that is adaptable to environments with different levels of development. HPV screening is only slowly replacing cytology as the primary screening option.
Current HPV vaccination programs in most countries target single or few cohorts of girls and young women. Phase III clinical trials with vaccines against HPV 16 and 18 have recently shown that protection is also very high for adult women (to ages 45+) provided they are HPV DNA negative at the time of vaccination. A novel HPV vaccine (Gardasil 9) has been licensed including antigens to 9 HPV types (6, 11, 16, 18, 31, 33, 45, 52 and 58) that cover 90% of the infections that cause cervical cancer worldwide.
Extending the age of vaccination to adult women combined with an adequate HPV screening and triage algorithm should be able to dramatically reduce mortality in areas of high risk. These campaign-type approaches have the potential to advance the reduction of cervical cancer incidence and mortality as compared to the time table in the reductions expected if only current programs of vaccination adolescent girls are maintained.