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Since 2006, when the first human papillomavirus (HPV) vaccine was approved, there has been much progress on the prevention of diseases associated with HPV infection, most notably cervical cancer. A decade earlier, the first validated HPV assay was approved in cervical cancer screening. As the two cervical cancer prevention fronts, i.e., primary via vaccination and secondary via screening, progressed more or less in parallel they have begun to intersect in recent years, as it has become clear that effective deployment of these strategies requires integration of resources and planning [1]. The enormous success of school-based vaccination programs and catch-up vaccination in many Western countries have already had an impact in reducing the prevalence of cervical precancerous lesions associated with the vaccine-targeted HPV genotypes [2]. The first cohorts of girls vaccinated against HPV will enter screening age during the next few years. As this happens, there is increasing acceptance that cervical cancer screening should rely on molecular testing for HPV, although screening algorithms differ regarding the need for cytology cotesting, triage method, ages to begin and exit screening, and testing interval. Can screening begin later in life, be done less frequently, and be stopped earlier among vaccinated women than among those who were not vaccinated? The answers to these questions are dependent on society’s tolerance for risk. Vaccination will have an impact on screening test performance and practices, ultimately reducing the benefit of screening as a preventive strategy. With the recent approval of a nine-valent HPV vaccine, maintenance of high vaccination coverage, and a pan-mucosotropic HPV vaccine in the horizon, the time will come in 30-40 years when we will have to decide if cervical cancer screening should be stopped [3,4]. It is imperative that we begin to consider the benchmarks of screening benefits and harms that will inform such a discussion.
1. Franco EL, Mahmud SM, Tota J, Ferenczy A, Coutlée F. The expected impact of HPV vaccination on the accuracy of cervical cancer screening: the need for a paradigm change. Arch Med Res. 2009; 40(6):478-85.
2. Drolet M, Bénard É, Boily MC, Ali H, Baandrup L, Bauer H, Beddows S, Brisson J, Brotherton JM, Cummings T, Donovan B, Fairley CK, Flagg EW, Johnson AM, Kahn JA, Kavanagh K, Kjaer SK, Kliewer EV, Lemieux-Mellouki P, Markowitz L, Mboup A, Mesher D, Niccolai L, Oliphant J, Pollock KG, Soldan K, Sonnenberg P, Tabrizi SN, Tanton C, Brisson M. Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis. 2015; 15(5):565-80.
3. Franco EL, Shinder GA, Tota JE, Isidean SD. Sobering realizations in cancer prevention and screening and their lessons. Prev Med. 2015 Jul;76:129-31.
4. El-Zein M, Richardson L, Franco EL. Cervical cancer screening of HPV vaccinated populations: Cytology, molecular testing, both or none. J Clin Virol. 2016; 76 Suppl 1:S62-8.