Cervical cancer in the human papillomavirus vaccination era

To evaluate the potential changes in the epidemiology of cervical cancer based on recently emerged information from mass vaccination programs beyond clinical trials.

Limited sensitivity and unequal access to screening have resulted in an imbalance in distribution of the burden of cervical cancer between developed and developing countries, between metropolitan and rural areas in developed countries, and among women from different ethnic groups. In screened populations, there is a relative increase in incidence of cervical cancer in young and elderly women, and an increased proportion of adenocarcinoma. A high coverage of the target population has been achieved in human papillomavirus (HPV) vaccination programs in many countries. After 3 years of mass vaccination of adolescent girls, surveillance data in Australia confirmed a significant reduction in high-grade abnormalities for girls aged 18 years and below.

HPV vaccination is more feasible than cytology screening for universal implementation across geographic sectors and demographic groups within individual countries and over the world. The high vaccine efficacy should significantly reduce the total burden and unequal distribution of invasive cervical cancer, including adenocarcinoma hitherto observed. These epidemiological changes provoke consideration for appropriate modifications of the current screening program.