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Abstract

Prevention of cervical cancer through HPV vaccination and HPV screening

Human papillomaviruses (HPV) play a causal role in the genesis of virtually all cancers of the uterine cervix. Most HPV infections regress spontaneously, progression to invasive cancer occurs only in the minority of infections with a minimal latency period of eight years and an average interval of 15 to 30 years. The HPV dependant genesis offers best chances to prevent cervical cancer either primarily with vaccines or secondarily with HPV screening.

The quadrivalent prophylactic HPV 6/11/16/18 as well as the bivalent HPV 16/18 vaccine are safe and efficient. Vaccinated individuals are almost completely protected from persistent infections with the HPV-types included in the vaccine. Because of some cross protection from related HPV types an overall 70 % to 80 % protection from highgrade cervical neoplasia can be expected. It seems that vaccine protection will be maintained for more than 20 years. The best efficiency of HPV vaccination is observed in girls prior to sexual debut.

A negative HPV test excludes almost any risk for the development of invasive cancer for more than 6 years. Primary HPV screening of women aged 30 years or older was significantly more efficient in detecting in CIN3 and preventing cervical cancer than cytology in meta-analyses of randomized controlled trials (RCTs). A first German primary HPV screening project was started in Wolfsburg 2006 and confirmed that the benefits observed in RCTs can be transferred in daily routine.

Combining HPV vaccination and HPV screening seems to be a promising way to eradicate cervical cancer. CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2012; 8(2): 162–175

Keywords
Human papillomavirus (HPV), primary HPV screening, vaccination, cervical intraepithelial neoplasia (CIN), cervical cancer

Karl Ulrich Petry
Klinikum der Stadt Wolfsburg, Klinik für Frauenheilkunde,
Geburtshilfe und Gynäkologische Onkologie, Wolfsburg

Reviewer: Eva Werner, Schwerin,
und Michael Wojcinski, Bielefeld

Petry K. U. Prävention ... Gynakol Geburtsmed Gynakol Endokrinol 2012; 8(2): 162–175 publiziert 31.07.2012 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2012 ISSN 1614-8533