Evidence for type replacement as a consequence of vaccination and implications for cervical screening

The success of prophylactic human papillomavirus (HPV) vaccination in reducing disease burden came with an epidemiological concern: HPV type replacement, the potential compensatory increase of nonvaccine targeted HPV types following the elimination of HPV16 and 18. Postvaccination surveillance across several countries suggests some signs of increase in the nonvaccine targeted HPV types, which may be explainable because of type replacement. However, should HPV type replacement be occurring, it is unlikely to generate disease replacement because of the significantly lower oncogenic potential of nonvaccine targeted HPV types. The modernization of screening to align with this new risk profile is necessary. Personalized screening protocols based on individual risk profiles informed by primary HPV testing with extended genotyping and future molecular triage to accurately risk-stratify HPV types are necessary in the postvaccination era.