HPV vaccines: bring me your daughters!

Abstract

Our approach to cervical cancer prevention is set to change dramatically over the next decade with the advent of human papillomavirus (HPV) DNA typing the probable demise of the PAP smear as we know it and the registration of two highly effective vaccines against the two main HPV types (16 and 18). The latter account for about 70% of all cervical cancer cases globally and for 63% of those in South African women. HPV-45 and HPV-31 account for another 10% of cases. Except for a minority of non-mainstream but remarkably visible and vocal groups and individuals the general consensus worldwide is that HPV vaccines herald a new era and a phenomenal advance in the fight against cervical cancer the most common cancer to affect women in South Africa and sub- Saharan Africa where the established co-factors of smoking long-term oral contraceptive use HIV co-infection and high parity are also operative. Lesotho has the unfortunate claim of the highest rate of cervical cancer in the world with an age standardised incidence rate of 61.6 (versus our 37.5) per 100 000 women. Women and health care providers have had to make two paradigm shifts around cervical cancer: firstly although most HPV infections clear naturally persistent infection with particular genotypes of a virus are responsible for most cases of cervical cancer (including the less common adenocarcinoma) and secondly close contact (as in both penetrative and nonpenetrative sex) is the main mode of infection. (excerpt)