Should all women be vaccinated against human papillomavirus and what effect will this have on screening programs?

Abstract

Persistent infection with high-risk human papillomavirus (HPV) is associated with the development of cancer of the cervix and vaccinating against HPV 16 and 18 results in almost complete protection against persistent infection and the development of cervical dysplasia caused by these HPV types. Current data support the rationale for vaccinating young women prior to sexual debut, but it is argued in this article that vaccinating all adult women may also be effective. Either approach will have an enormous impact, both positive and negative, on current screening programs and planning to both measure and respond will need to form a part of any organized vaccination program. The ideal way to ensure this is by linking vaccination registers with Papanicolau smear screening registers or by developing novel information systems. Continual and intensive monitoring of the situation will be necessary for at least the next 15–20 years.