[Screening and vaccine: toward an integrated cervical cancer prevention programme]

The identification of the human papilloma virus (HPV) as the necessary cause of cervical cancer introduced two new tools for prevention: HPV DNA test and vaccine. In this paper we analyse the plausible changes that will happens in the cervical cancer prevention in Italy and what we will need to have a governance of these changes. From a public health point of view, screening and vaccination are interventions directed to the whole community and their goal is to reach high coverage of the target population. The vaccinated women should be screened with different algorithms from the non-vaccinated ones, consequently we need individual information about the vaccination status of the women that we are going to invite for screening. Vaccine and screening interventions must be integrated in a unique public health program and screening should use less aggressive protocols, to be less expensive and more sustainable and efficient. The challenge for the Health Service is to integrate the primary and secondary prevention avoiding that one will diminish the benefits of the other and that the introduction of new technologies will be only the opportunity to double the costs with minimal health benefits.