Current direction in the prevention of cervical cancer

Cervical screening seems to benefit a minor part of the world female population, and yet women who benefit from it still prove its weaknesses. The fact that these genital lesions are the consequence of a chronic genital infection with HPV opens new and extraordinary opportunities for prevention through vaccination. The highest efficacy is demonstrated in young women naive to the virus types associated with the vaccines. The effectiveness of HPV vaccines are limited by two factors: all genital cancers and precancerous lesions are not induced exclusively by HPV types 16 and 18, and the optimal benefit is demonstrated in adolescents and young women before they have encountered these viruses. Vaccination and screening act complementarily and synergistically, and constitute to date the new standards of disease prevention.

Cervical intraepithelial neoplasia; Cervical cancer; Genital warts; HPV vaccines; Human papillomavirus

[1] Monsonego J.: "Emerging Issues on HPV Infections: From Science to Practice". Basel, Karger, 2006.

[2] Monsonego J.: "Traite des infections genitales a papillomavirus". Paris, Springer, 2007.

[3] Future II Study Group: "Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions". N. Engl. J. Med., 2007, 356, 1915.

[4] Garland S.M., Hernandez-Avila M., Wheeler C.M., Perez G., Harper D.M., Leodolter S. et al.: "Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases". N. Engl. J. Med., 2007, 356, 1928.

[5] Harper D., Franco E., Wheeler C., Moscicki A., Romanows灼B., Roteli-Martins C. et al.: "Sustained efficacy up to 4-5 years of a bivalent LI virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial". Lancet, 2006, 365, 1247.

[6] Joura E.A., Leodolter S., Hernandez-Avila M., Wheeler C.M., Perez G., Koutsky L.A. et al.: "Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) LI virus-like-particle vaccine against high-grade vulva! and vaginal lesions: a combined analysis of three randomised clinical trials". Lancet, 2007, 369, 1693.

[7] Paavonen J., Jenkins D., Bosch F.X., Naud P., Salmeron J., Wheeler C.M. et al.: "Efficacy of a prophylactic adjuvanted bivalent LI virus-likeparticle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial". Lancet, 2007, 369, 2161.

[8 J Ault K.A., Future II Study Group: "Effect of prophylactic human papillomavirus LI virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trials". Lancet, 2007, 369, 1861.

[9] Villa L.L., Costa R.L., Petta C.A., Andrade R.P., Ault K.A., Giuliano A. et al.: "Prophylactic quadrivalent human papillomavirus (types 6, 11,16, and 18) LI virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial" Lancet Oneal., 2005, 6, 271.

[10] Villa L.L., Costa R.L., Petta C.A., Andrade R.P., Paavonen J., Iversen O.E. et al.: "High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 LI virus-like particle vaccine through 5 years of follow-up". Br. J. Cancer, 2006, 95, 1459.

[11] Barr E.: "Methodology for analysis of the efficacy of quadrivalent HPV vaccine against non vaccine types (Abstract)". Eurogin, 2007, October 4-6, Monte-Carlo, Monaco.

[12] Hildesheim A., Herrero R., Wacholder S., Rodriguez A.C., Solomon D., Concepcion Bratti M. et al.: "Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection: a randomized trial". JAMA, 2007, 298, 743.