HPV vaccination and cervical cancer screening

Screening can cause harm (eg, anxiety, further tests, diagnostic labels, costs, morbidity, and death). Sometimes, a screening programme can bring net benefits when the Wilson and Jungner criteria are applied.1UK National Screening CommitteeCriteria for appraising the viability, effectiveness and appropriateness of a screening programme.https://www.gov.uk/government/publications/evidence-review-criteria-national-screening-programmes/criteria-for-appraising-the-viability-effectiveness-and-appropriateness-of-a-screening-programmeDate: Oct 23, 2015Date accessed: December 19, 2021Google Scholar Screening can detect problems too early, leading to overdiagnosis and overtreatment, resulting in high financial costs, morbidity, and death. Screening healthy people should be considered a medical failure, a second-rate and burdensome approach, and at best should be a temporary, contingent stopgap between the real successes of prevention and cure. Screening (of healthy people) and early diagnosis (with speedy management of symptomatic patients) are ethically and scientifically distinct, but often wrongly elided.2NHS England and NHS ImprovementScreening and earlier diagnosis.https://www.england.nhs.uk/cancer/early-diagnosis/screening-and-earlier-diagnosis/Date accessed: December 19, 2021Google Scholar The UK National Health Service, policy makers, and the general public need to understand that programmes should be continuously interrogated and dismantled as they become redundant to release funds for something more effective and to liberate people from the constant anxiety of routine check-ups and self-checking. The preliminary observational data about the effects of England's national human papillomavirus (HPV) vaccination programme from Milena Falcaro and colleagues’ study1UK National Screening CommitteeCriteria for appraising the viability, effectiveness and appropriateness of a screening programme.https://www.gov.uk/government/publications/evidence-review-criteria-national-screening-programmes/criteria-for-appraising-the-viability-effectiveness-and-appropriateness-of-a-screening-programmeDate: Oct 23, 2015Date accessed: December 19, 2021Google Scholar show that the programme has almost eliminated cervical cancer and precancer, albeit data only being available for women up to age 25 years.3Falcaro M Castañon A Ndlela B et al.The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study.Lancet. 2021; 398: 2084-2092Summary Full Text Full Text PDF PubMed Scopus (103) Google Scholar The positive implications of changing the natural history of this disease were not anticipated or addressed.3Falcaro M Castañon A Ndlela B et al.The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study.Lancet. 2021; 398: 2084-2092Summary Full Text Full Text PDF PubMed Scopus (103) Google Scholar, 4Cruickshank ME Grigore M Cervical cancers avoided by HPV immunisation.Lancet. 2021; 398: 2053-2055Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar It is inevitable that the death and morbidity trade-offs will change from benefits towards harms, especially given the known lifelong risks of prematurity in the offspring of women with surgically damaged cervices.5Kyrgiou M Athanasiou A Kalliala IEJ et al.Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease.Cochrane Database Syst Rev. 2017; 11CD012847 PubMed Google Scholar The criteria for the screening programme should be reviewed to determine if and when it should be offered to only those who have not had an HPV vaccination. Cervical cancer screening at the population level should not continue when previous harm to benefit weighings and justification have vanished.SB is chair of HealthSense UK and declares no other competing interests. Screening can cause harm (eg, anxiety, further tests, diagnostic labels, costs, morbidity, and death). Sometimes, a screening programme can bring net benefits when the Wilson and Jungner criteria are applied.1UK National Screening CommitteeCriteria for appraising the viability, effectiveness and appropriateness of a screening programme.https://www.gov.uk/government/publications/evidence-review-criteria-national-screening-programmes/criteria-for-appraising-the-viability-effectiveness-and-appropriateness-of-a-screening-programmeDate: Oct 23, 2015Date accessed: December 19, 2021Google Scholar Screening can detect problems too early, leading to overdiagnosis and overtreatment, resulting in high financial costs, morbidity, and death. Screening healthy people should be considered a medical failure, a second-rate and burdensome approach, and at best should be a temporary, contingent stopgap between the real successes of prevention and cure. Screening (of healthy people) and early diagnosis (with speedy management of symptomatic patients) are ethically and scientifically distinct, but often wrongly elided.2NHS England and NHS ImprovementScreening and earlier diagnosis.https://www.england.nhs.uk/cancer/early-diagnosis/screening-and-earlier-diagnosis/Date accessed: December 19, 2021Google Scholar The UK National Health Service, policy makers, and the general public need to understand that programmes should be continuously interrogated and dismantled as they become redundant to release funds for something more effective and to liberate people from the constant anxiety of routine check-ups and self-checking. The preliminary observational data about the effects of England's national human papillomavirus (HPV) vaccination programme from Milena Falcaro and colleagues’ study1UK National Screening CommitteeCriteria for appraising the viability, effectiveness and appropriateness of a screening programme.https://www.gov.uk/government/publications/evidence-review-criteria-national-screening-programmes/criteria-for-appraising-the-viability-effectiveness-and-appropriateness-of-a-screening-programmeDate: Oct 23, 2015Date accessed: December 19, 2021Google Scholar show that the programme has almost eliminated cervical cancer and precancer, albeit data only being available for women up to age 25 years.3Falcaro M Castañon A Ndlela B et al.The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study.Lancet. 2021; 398: 2084-2092Summary Full Text Full Text PDF PubMed Scopus (103) Google Scholar The positive implications of changing the natural history of this disease were not anticipated or addressed.3Falcaro M Castañon A Ndlela B et al.The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study.Lancet. 2021; 398: 2084-2092Summary Full Text Full Text PDF PubMed Scopus (103) Google Scholar, 4Cruickshank ME Grigore M Cervical cancers avoided by HPV immunisation.Lancet. 2021; 398: 2053-2055Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar It is inevitable that the death and morbidity trade-offs will change from benefits towards harms, especially given the known lifelong risks of prematurity in the offspring of women with surgically damaged cervices.5Kyrgiou M Athanasiou A Kalliala IEJ et al.Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease.Cochrane Database Syst Rev. 2017; 11CD012847 PubMed Google Scholar The criteria for the screening programme should be reviewed to determine if and when it should be offered to only those who have not had an HPV vaccination. Cervical cancer screening at the population level should not continue when previous harm to benefit weighings and justification have vanished. SB is chair of HealthSense UK and declares no other competing interests. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational studyWe observed a substantial reduction in cervical cancer and incidence of CIN3 in young women after the introduction of the HPV immunisation programme in England, especially in individuals who were offered the vaccine at age 12–13 years. The HPV immunisation programme has successfully almost eliminated cervical cancer in women born since Sept 1, 1995. Full-Text PDF HPV vaccination and cervical cancer screeningMilena Falcaro and colleagues1 reported that cervical cancer and grade 3 cervical intraepithelial neoplasia (CIN3) were prevented by a bivalent vaccine (Cervarix). The study showed that Cervarix was more effective against CIN3 than cervical cancer. Considering that human papillomavirus 16 (HPV16) and HPV18 account more for cervical cancer than CIN3, it is reasonable to assume that Cervarix prevents cervical cancer more than CIN3. In a 2007 phase 3 study, bivalent HPV vaccine showed high efficacy, preventing 90·4% of grade 2 CIN or worse. Full-Text PDF HPV vaccination and cervical cancer screening – Authors' replyWe agree with Susan Bewley's suggestion that cervical screening should be reviewed in light of human papillomavirus (HPV) vaccination. We have published suggesting that women vaccinated with either the bivalent or quadrivalent vaccine at ages 11–15 years might be screened on just three occasions (approximately at ages 30, 40, and 55 years), and that women vaccinated with the nonavalent vaccine might be screened just twice.1 Our observations2 suggest that even less frequent screening might be appropriate (for those who received the bivalent vaccine) and that herd protection might reduce the need for more intensive screening in unvaccinated members of vaccinated cohorts. Full-Text PDF