HPV AND CERVICAL CANCER PREVENTION

  • Marjetka Uršič-Vrščaj Onkološki inštitut Ljubljana, Zaloška cesta 2, 1000 Ljubljana
  • Milan Bašković Onkološki inštitut Ljubljana, Zaloška cesta 2, 1000 Ljubljana
  • Sonja Bebar Onkološki inštitut Ljubljana, Zaloška cesta 2, 1000 Ljubljana
  • Astrid Djurišić Onkološki inštitut Ljubljana, Zaloška cesta 2, 1000 Ljubljana
  • Vida Stržinar Onkološki inštitut Ljubljana, Zaloška cesta 2, 1000 Ljubljana
  • Aleš Vakselj Onkološki inštitut Ljubljana, Zaloška cesta 2, 1000 Ljubljana
Keywords: HPV, cervical cancer, screening, HPV test, HPV vaccination

Abstract

Background: The causal role of human papilloma virus (HPV) in all cancers of the uterine cervix has been firmly established biologically and epidemiologically. HPV types 16 and 18 account for about 70 % of the cases worldwide.

HPV has been recognized as a necessary cause of cervical cancer, meaning that in the absence of the persistent presence of HPV DNA in the cervical cells, cervical cancer will not occur. Thus preventive strategies based on HPV testing in screening programmes or HPV type-specific vaccination are based on solid ground. Most cancers of the vagina and anus are likewise caused by HPV 16, as are a siteable fraction of cancers of the vulva, the penis and the oropharynx. Cervical cancer screening can be a highly effective secondary intervention. In the developing countries these programmes are either not available or are ineffective. HPV vaccination represents the most effective intervention in that scenario. Prophylactic vaccination with human papillomavirus (HPV) virus-like particle (VPL) vaccines against HPV 16 and HPV 18, has transformed our prospects for reducing the in- cidence of cervical cancer on global scale. HPV vaccines are immunogenic, well tolerated and show remarkable efficacy. Screening will have to continue, as two of the 15 oncogenic HPV types are in the vaccines and for two to three decades at least unvaccinated sexually active women still remain at risk for the disease.

Conclusions: If vaccination, screening and HPV testing are combined then the virtual elimination of cervical cancer is possible.

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References

Arbyn M. European guidelines for quality assurance in cervical cancer screening. 2nd ed. Luxemburg: Office for official publica- tions of the European Communities; 2008.

Bosch FX, Lorincz A, Muñoz N, Meijer CJ, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 2002; 55: 244–65.

Bosch FX, Castellsagué X, de Sanjosé S. HPV and cervical cancer: screening or vaccination? Br J Cancer 2008; 98: 15–21.

JouraEA,LeodolterS,Hernandez-AvilaM,WheelerCM,PerezG, Koutsky LA, et al. Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like-particle vac- cine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet 2007; 369: 1693–702.

FutureIIStudyGroup.Thequadrivalentvaccineagainsthuman papillomaviruse to prevent high-grade lesions. N Engl J Med 2007; 356: 1915–27.

GarlandSM,Hernandez-AvilaM,WheelerCM,PerezG,Harper DM, Leodolter S, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. New Engl J Med 2007; 356: 1928–43.

Muñoz N, Manalastas R Jr, Pitisuttithum P, Tresukosol D, Mon- sonego J, Ault K, et al. Safety, immunogenicity, and efficacy of quadrivalent human papillomavirus (types 6, 11, 16, 18) recombi- nant vaccine in women aged 24–45: a randomised, double-blind trial. Lancet 2009; 373: 1949–57.

HarperDM,FrancoEL,WheelerCM,MoscickiAB,Romanowski B, Roteli-Martins CM, et al. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillo- mavirus types 16 and 18: follow-up from a randomised control trial. Lancet 2006; 367: 1247–55.

PaavonenJ,JenkinsD,BoschFX,NaudP,SalmerónJ,Wheeler CM, et al. Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papil- lomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet 2007; 369: 2161–70.

HildesheimA,HerreroR,WacholderS,RodriguezAC,Solomon D, Bratti MC, et al. Effect of human papillomavirus 16/18 L1 vi- ruslike particle vaccine among young women with preexisting infection: a randomized trial. JAMA 2007; 298: 743–53.

Stanley M. Human Papillomaviruse vaccines versus cervical cancer screening. Clinl Oncol 2008; 20: 388–94.

ArbynM,BuntinxF,VanRanstM,ParaskevaidisE,Martin-Hirsch P, Dillner J, et al. Virologic versus cytologic triage of women with equivocal Pap smears: a meta-analysis of the accuracy to detect high-grade intraepithelial neoplasia. J Natl Cancer Inst 2004; 96 (4): 280–93.

ZielinskiGD,BaisAG,HelmerhorstTJ,VerheijenRH,deSchipper FA, Snijders PJ, et al. HPV testing and monitoring of women after treatment of CIN 3: review of the literature and meta-analysis. Obstet Gynecol Surv 2004; 59: 543–53.

Incidenca raka v Sloveniji 2005. Ljubljana: Onkološki inštitut, Register raka za Slovenijo; 2008.

Primic-Žakelj M, Pogačnik A, Uršič-Vrščaj M. Poročilo o rezul- tatih državnega programa ZORA v letih 2006 in 2007. Ljubljana: Onkološki inštitut, 2007.

Published
2018-02-14
How to Cite
1.
Uršič-VrščajM, BaškovićM, Bebar S, DjurišićA, StržinarV, Vakselj A. HPV AND CERVICAL CANCER PREVENTION. ZdravVestn [Internet]. 14Feb.2018 [cited 27Jan.2020];78. Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/2732
Section
Review