European Journal of Obstetrics & Gynecology and Reproductive Biology
Expert opinionNew paradigm for prevention of cervical cancer
Introduction
Cervical cancer can be prevented by eliminating genital infections with oncogenic human papillomaviruses (HPV). This strategy of primary prevention comprises stopping a pandemic viral infection that (i) can affect nearly everyone, (ii) causes half a million cancer cases worldwide, and (iii) is responsible for 250,000 deaths among women each year.
When human papillomaviruses were detected in warts and cervical cancer for the first time in the early 1980s, only a few scientists predicted that this infection was an invariably necessary step in the induction of cervical cancer [1], [2], [3], [4]. Today, we are witnessing the introduction of the first generation of prophylactic vaccines against the most prevalent HPV types in cervical cancer and genital warts. Molecular and epidemiological studies have proven that it is the two viruses, HPV16 and HPV18, out of approximately 18 “oncogenic” or “high-risk” types that are responsible for 70% of cervical cancers [5]. HPV6 and HPV11 induce 90% of genital warts, thus contributing significantly to anogenital disease and discomfort.
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Prophylactic vaccines
Two major pharmaceutical companies have developed highly immunogenic and protective prophylactic vaccines, which in phase II and III clinical trials have thus far been shown to be safe and effective for up to 5 years.
GlaxoSmithKline has developed a bivalent vaccine, Cervarix®, against HPV16 and HPV18, targeting anogenital cancers. Sanofi-Pasteur MSD/Merck has included HPV6, 11, 16, and 18 as a quadrivalent vaccine, targeting both genital warts and cancer (Gardasil®). Based on the recombinant
Implementation
Reducing 80% of cervical cancers could result in the prevention of 400,000 cancer cases in women and approximately 200,000 deaths worldwide. There is the potential risk that other HPV types will fill in the niche when HPV16 and HPV18 are eliminated. Recent epidemiological data, however, show that of all high-risk HPV types, HPV16 and 18 confer the highest risk of dysplasia over a period of up to 10 years [14], [15].
Other vaccination programs against hepatitis, polio, and childhood infections
Practical issues
The introduction of a vaccine against a sexually transmitted virus certainly faces particular difficulties. Ethical, religious, cultural, and social issues have to be taken into consideration [22]. This is an issue in particular when matronized and/or patronized young adolescents of 9–15 years of age are the main target group of a vaccination program. Adequate communication strategies must be developed and information needs to be transmitted in an adoptable way. Consensus statements,
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Cited by (14)
Health care professional communication about STI vaccines with adolescents and parents
2014, VaccineCitation Excerpt :This attention could lead to mixed messages about STI vaccines, which, in turn, may impact HCP practices. For example, while some strongly supported HPV vaccination as the new paradigm in cervical cancer prevention [55], others questioned HPV vaccine safety and efficacy, clinical trial conduct, and informed consent policies for vaccination [56,57]. Skepticism among some Dutch scientists about the HPV vaccine, including issues of safety, may have impacted HCPs and confused the public [58].
Prospects and challenges in the introduction of human papillomavirus vaccines in the extended middle east and North Africa Region
2013, VaccineCitation Excerpt :The price for the three-dose series in the private markets of EMENA countries ranges from $330 for the bivalent vaccine to $600 for the quadrivalent vaccine. For most EMENA countries, particularly middle-income countries that are not eligible for GAVI support, this is beyond the financial means of the majority of the population [40]. It would be expected that if governments chose to include HPV vaccine on their EPI schedule, they would be able to procure it at a much lower price.
HPV infections: Can they be eradicated using nanotechnology?
2012, Nanomedicine: Nanotechnology, Biology, and MedicineKnowledge about infection with human papillomavirus: A systematic review
2008, Preventive MedicineCitation Excerpt :A vaccine that protects against HPV 16 and 18 is expected to be licensed in the near future (Arbyn and Dillner, 2007). Both prophylactic vaccines against HPV have been assessed in large clinical trials and have been shown to be well tolerated and efficacious (Koutsky et al., 2002; Harper et al., 2004; Villa, 2005; Arbyn and Dillner, 2007; Kaufmann and Schneider, 2007). There is evidence that acceptance of HPV vaccination is increased when parents or young women were well informed about the risks and benefits (Kahn et al., 2003; Davis et al., 2004), although this was not found consistently (Dempsey et al., 2006).
Comment on "new paradigm for prevention of cervical cancer" [Eur J Obstet Gynecol Reprod Biol 2007;130(1):25-9]
2007, European Journal of Obstetrics and Gynecology and Reproductive BiologyAwareness, outlook & general belief regarding cervical cancer and its prevention in women attending gynaecology OPD in rural setup in West Bengal
2018, Journal of the Indian Medical Association