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Eur J Cancer. 2009 Oct;45(15):2714-21. doi: 10.1016/j.ejca.2009.07.024. Epub 2009 Aug 18.

What's next? Perspectives and future needs of cervical screening in Europe in the era of molecular testing and vaccination.

Author information

  • 1Institute of Public Health, University of Copenhagen, Østre Farimagsgade 5, DK 1014 København K, Denmark. elsebeth@pubhealth.ku.dk

Abstract

AIM:

To outline the perspectives for future control of cervical cancer in Europe.

METHODS:

Review of current status for major cervical cancer control tools. The review was based on PubMed searches for cervical cancer prevention, Human Papillomavirus, HPV-test, HPV-vaccination, and treatment with large loop excision of the transformation zone, LLETZ.

RESULTS:

Recent studies suggest that condom use offers some but not complete protection against HPV-infection. High quality cytology screening with good population coverage reduces the incidence and mortality of cervical cancer. Randomised controlled trials have found HPV-testing to increase the detection rate of cervical intraepithelial neoplasia grade 2+, CIN2+, compared with cytology. Two studies found a decreased detection rate of CIN3+ in the HPV-testing arm at the subsequent screening. Randomised controlled trials found that women not infected with vaccine HPV-types at vaccination are well protected against CIN2+ from these HPV-types, but the vaccine does not protect against CIN2+ from other HPV-types and neither does it protect already HPV infected women. There is an increased risk of adverse obstetric outcomes following excisional treatment.

CONCLUSIONS:

The future of cervical cancer control may become a diversified strategy, one for non-vaccinated birth cohorts and another for vaccinated cohorts. It will take another 50 years before the non-vaccinated cohorts have passed the screening age. With the current uncertainty concerning the long term protection from HPV-vaccination it will furthermore be precautionary to continue screening practice for the first cohorts of HPV-vaccinated women. Organised vaccination and screening programmes with good record keeping are necessary to optimise the future control of cervical cancer.

PMID:
19695870
[PubMed - indexed for MEDLINE]
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