To vaccinate or to screen--is that the question?

The recent recommendation by the Joint Committee on Vaccination and Immunisation (JCVI) that the human papillomavirus (HPV) vaccine should be routinely given to girls aged 12-13 raises important questions about prevention programmes to combat cervical cancer in the UK. The proposal of a mass immunization programme against HPV also presents some important ethical dilemmas. This paper discusses these questions within the current context of cervical cancer prevention programmes considering issues of efficacy and the impact of immunization on women and the implications for the current cervical screening programme. We argue that despite the JCVI recommendation to implement a national vaccination programme in the UK, which will undoubtedly save lives, further consideration needs to be given to key concerns about the efficacy of the delivery programme and potential risks associated with this, the additional costs of delivery of such a programme, the challenge of ensuring continued vaccination coverage among the highest risk population, the goals of the vaccination programme and the need to continue cervical cancer screening despite a vaccination programme.