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HPV screening, vaccination may eradicate cervical cancer in near future
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ECCO 15 – ESMO 34 Multidisciplinary Congress
HPV screening, rather than the Pap smear test, may help identify more women with cervical cancer, and vaccinating against the disease may help eradicate it within the next 50 years, according to Jack Cuzick, PhD, who presented information on this topic at the ECCO 15 – ESMO 34 Multidisciplinary Congress, held in Berlin.
The current HPV vaccines protect against two cancer-causing strains of the HPV virus. However, vaccines are in clinical trials that are designed to protect against nine strains, according to a press release.
The current vaccine can eradicate 70% to 75% of cervical cancers caused by HPV types 16 and 18, and there appears to be some cross-protection against types closely related to these. However, if the new vaccines — meant to protect against nine types — are successful, there should be no need to screen women who have already been vaccinated, according to Cuzick, John Snow professor of epidemiology and head of Cancer Research U.K. Center for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine in London.
“Screening will have challenges in the post-vaccination period because once women are vaccinated, fewer of them are actually going to develop the precursors and go on to develop the cancer,” Cuzick said during a press conference. “Current screening will be less cost effective because there will be less disease out there to detect. [Therefore] we’re going to need better methods, and that’s another reason for wanting to move to HPV based screening tests.”
Because the Pap smear test relies on subjective assessment, it is prone to human error and misses about one-third to half of all high-grade lesions, whereas the HPV test is almost completely automated and designed to detect the virus in the smear instead of relying on human visual exam.
“There are now several available commercial HPV tests, and most of these tests show a sensitivity in the order of 95% for high-grade lesions, whereas cytology is somewhere between 50% to 70%,” Cuzick said in a press release.
He suggested that the European Union and national governments take the initiative in discussions on implementing screening and vaccination programs rather than rely on drug companies as there is often skepticism associated with pharmaceutical-based education programs.
Also, although HPV testing is more costly than cytology testing, over time the cost would decrease due to test volume and longer intervals between testing. Cuzick suggested that younger women undergo HPV testing every five years starting at age 25 to 30. After the age of 50, women who have tested negative could be screened every eight years.
“The main message we need to get across to European government and providers is that cervix cancer is virtually 100% preventable; it’s the only cancer where there is a single known cause. Over 99% of cervix cancers have the human papillomavirus in them; this virus is the single cause for this one cancer,” Cuzick said. – by Christen Haigh
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There is a strong rationale to consider HPV testing as a major component of a cervix cancer screening strategy. However, such a testing strategy is currently more expensive than a Pap smear, and until the costs associated with an evaluation of HPV are brought down substantially, it is highly unlikely most countries in the developing world (where cervix cancer is of greatest concern) will be able to employ this approach.
– Maurie Markman, MD
HemOnc Today Editorial Board member
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