Human papillomavirus vaccination: An important tool in cervical cancer elimination

Abstract

The World Health Organization (WHO) has called for global elimination of cervical cancer, which essentially means achieving age-standardized incidence rates of <4/100,000 women worldwide, so that it ceases to be a public health issue. Vaccination against the human papillomavirus (HPV), screening for cervical cancer, and the treatment of precancerous lesions are effective tools for achieving this goal. HPV vaccination is recommended as a primary prevention measure in young girls before their sexual debut, and screening for cervical cancer is recommended for sexually active women. Three types of HPV vaccines are available-bivalent, quadrivalent, and 9-valent vaccines. Standard dosing recommended is the 3-dose regimen, whereas, in young girls between 9 and 15 years, 2-dose schedule is found to be as immunogenic as the 3-dose schedule. Countries like Australia have implemented vaccination using the quadrivalent HPV vaccine, and a large impact on HPV-related disease has been noted in Australia. Screening for cervical cancer can be done by cervical cytology, visual inspection after application of acetic acid (VIA), or HPV DNA testing. Low-cost screening techniques like VIA are useful in our country for large scale screening. Challenges in achieving elimination of cervical cancer are manifold and include vaccine manufacture and delivery, vaccine hesitancy, setting up of cervical screening and effective treatment of precursors, and, most importantly, availability of resources to fund screening and vaccination to a huge population. In developing countries like ours, the WHO goal can be achieved only by the commitment of state and central governments and nongovernment organizations.