Cervical cancer screening at crossroads

TY - JOUR

T1 - Cervical cancer screening at crossroads

AU - Lynge, Elsebeth

AU - Rygaard, Carsten

AU - Baillet, Miguel Vazquez-Prada

AU - Dugué, Pierre-Antoine

AU - Sander, Bente Braad

AU - Bonde, Jesper

AU - Rebolj, Matejka

N1 - © 2014 APMIS. Published by John Wiley & Sons Ltd.

PY - 2014/8

Y1 - 2014/8

N2 - Cervical screening has been one of the most successful public health prevention programmes. For 50 years, cytology formed the basis for screening, and detected cervical intraepithelial lesions (CIN) were treated surgically to prevent progression to cancer. In a high-risk country as Denmark, screening decreased the incidence of cervical cancer from 34 to 11 per 100,000, age-standardized rate (World Standard Population). Screening is, however, also expensive; Denmark (population: 5.6 million) undertakes close to half a million tests per year, and has 6-8 CIN-treated women for each prevented cancer case. The discovery of human papillomavirus (HPV) as the cause of cervical cancer dramatically changed perspectives for disease control. Screening with HPV testing was launched around 1990, and preventive HPV vaccination was licensed in 2006. Long-term randomized controlled trials (RCT) demonstrated that HPV testing provides better protection against cervical cancer than cytology, but it requires extra repeated testing. HPV vaccination RCTs, furthermore, have proved that HPV vaccination protects against vaccine-type high-grade CIN in women vaccinated prior to sexual activity, but less so in women vaccinated later. The challenge now is therefore to find an algorithm for screening of a heterogeneous population including non-vaccinated women; women vaccinated prior to start of sexual activity; and women vaccinated later.

AB - Cervical screening has been one of the most successful public health prevention programmes. For 50 years, cytology formed the basis for screening, and detected cervical intraepithelial lesions (CIN) were treated surgically to prevent progression to cancer. In a high-risk country as Denmark, screening decreased the incidence of cervical cancer from 34 to 11 per 100,000, age-standardized rate (World Standard Population). Screening is, however, also expensive; Denmark (population: 5.6 million) undertakes close to half a million tests per year, and has 6-8 CIN-treated women for each prevented cancer case. The discovery of human papillomavirus (HPV) as the cause of cervical cancer dramatically changed perspectives for disease control. Screening with HPV testing was launched around 1990, and preventive HPV vaccination was licensed in 2006. Long-term randomized controlled trials (RCT) demonstrated that HPV testing provides better protection against cervical cancer than cytology, but it requires extra repeated testing. HPV vaccination RCTs, furthermore, have proved that HPV vaccination protects against vaccine-type high-grade CIN in women vaccinated prior to sexual activity, but less so in women vaccinated later. The challenge now is therefore to find an algorithm for screening of a heterogeneous population including non-vaccinated women; women vaccinated prior to start of sexual activity; and women vaccinated later.

KW - Adolescent

KW - Adult

KW - Cervical Intraepithelial Neoplasia

KW - Denmark

KW - Early Detection of Cancer

KW - Female

KW - Humans

KW - Mass Screening

KW - Middle Aged

KW - Papillomaviridae

KW - Papillomavirus Infections

KW - Papillomavirus Vaccines

KW - Uterine Cervical Neoplasms

KW - Vaccination

KW - Vaginal Smears

KW - Young Adult

U2 - 10.1111/apm.12279

DO - 10.1111/apm.12279

M3 - Journal article

C2 - 25046198

SN - 0903-465X

VL - 122

SP - 667

EP - 673

JO - APMIS. Supplementum

JF - APMIS. Supplementum

IS - 8

ER -