Since 2006, when the first human papillomavirus (HPV) vaccine was approved, there has been much progress on the uptake of HPV vaccination in high and middle income countries. Australia, the first adopter of public, adolescent female HPV vaccination, coincidentally has had an organized program of cervical cancer screening for women 18-years of age and over, which permitted it to have an early surveillance mechanism to demonstrate an impact of vaccination in reducing the incidence of cervical precancerous lesions. As vaccination programs reach their 10th year anniversary, other countries have documented an impact in reducing the prevalence of cervical precancerous lesions associated with the vaccine-targeted HPV genotypes, replicating the findings from Australia. Another evidence of impact is the reduction in prevalence of vaccine-targeted genotypes in surveys conducted before and after the rollout of vaccination, which has been demonstrated in the US. In countries whose screening programs begin at or after age 25, 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 to risk. Few countries have begun pondering about the changes in screening that will have to be made, as well as the necessary information systems for surveillance, when a substantial proportion of women in the population have already been vaccinated.
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