Cervical cancer screening following the implementation of prophylactic human papillomavirus vaccination

The recognition that infection with certain human papillomavirus (HPV) types is a necessary cause of cervical cancer has opened new fronts in the prevention of this disease. Primary prevention is now possible via immunization with highly efficacious HPV vaccines, and secondary prevention has gained impetus with the advent of sensitive HPV-DNA testing to improve traditional Pap cytology screening programs. Although universal vaccination of teenagers and young women is a desirable policy, cost remains a key obstacle. To achieve cost-effective reductions in cervical cancer burden, prevention initiatives must consider screening and immunization as integrated and organized approaches that take advantage of HPV testing as a primary screening test followed by triage with Pap cytology. This strategy has the added benefit of providing immunosurveillance of vaccinated populations.