HPV-vaccination programs constitute major public-health initiatives worldwide and have been introduced into National immunisation programs in over 80 countries, although most are in high income countries. Programs were implemented around 10 years ago: where high coverage of target populations especially with catch-up programs, the impact and effectiveness on HPV infection and disease has been remarkable. For the quadrivalent vaccine (6/11/16/18) there have been reductions of ∼90% for HPV vaccine type infections, ∼90% for genital warts, ∼45% for low-grade cytological cervical abnormalities, ∼60% for cervical histologically-proven high-grade abnormalities [HSIL], in colposcopic referrals, and ablative therapy. Thus, the positive predictive value of cervical cytology [Pap screening] for underlying HSIL has reduced: accordingly, countries are adopting new screening strategies using more sensitive, more objective methods of HPV nucleic acid tests (NAT). In 2017 Australia, screening changed to HPV NAT assays commencing at 25 years of age, with immediate triage to cytology and colposcopy if HPV16/18 positive, and five yearly screening for those HPV DNA negative. It is important that NAT assays chosen must strike a balance between sufficient clinical sensitivity to detect/predict HSIL, without being too sensitive (detecting transient infection only not destined to becoming lesions). The highest quality HPV NAT is thus a priority to reduce falsely negative screens and manage the risk associated with false positive HPV NAT test results. It is imperative that we adopt the best QA and QC measures to accompany the introduction of these new assays. Today we are poised to markedly reduce the incidence of cervical cancer, with the vision of eventually eliminating it as a public health problem (as the call to action from WHO DG Dr Tedros May 2018), using the combination of sustained high coverage HPV vaccination and sustained high coverage HPV NAT screening, with treatment of those with disease.
Disclosure No significant relationships.
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