Background: A second generation nonavalent HPV vaccine (HPV9; Gardasil-9) has been recommended for use in the US, approved for use in the European Union and is currently being evaluated in several other developed countries. In females fully vaccinated prior to HPV exposure, HPV9 is expect to protect against ~90% of cervical cancers. HPV9 is being introduced in the context of established cervical screening approaches but the long term implications for screening are unclear.
Objective: This talk will review the issues to be considered with respect to the role of cervical screening in the context of HPV9.
A number of key considerations, which will differ between countries, will be reviewed including: (1) the timing for expected impact on screening, which in most countries is expected to be a decade or more and will depend on the age at HPV9 vaccination in relation to the starting age of screening; (2) whether tailored screening approaches depending on a woman’s vaccination status will be attempted; such ‘individualised’ approaches will require comprehensive and reliable vaccine registry systems; (3) the impact of vaccine coverage rates and herd immunity effects on decision-making for screening; (4) the population attributable fraction of HPV9-included types to invasive cervical cancer in different regions; and (5) the costs and cost-effectiveness of continuing to deliver comprehensive screening.
Cervical screening will require re-evaluation to determine what screening, if any, will be required in cohorts offered HPV9. It is likely that ‘abbreviated’ strategies, perhaps involving only one or a few primary HPV screens in a lifetime, will be appropriate in women known to have been vaccinated with HPV9, or in cohorts with high coverage for HPV9 vaccination.