Abstract

Evaluating the potential benefits of universal worldwide human papillomavirus vaccination

Author(s): F Xavier Bosch, Silvia de Sanjos�?© and Xavier Castellsagu�?©

Human papillomavirus (HPV) vaccines have opened a new perspective to the prevention of many cancers, mainly cervical cancer, one of the most paradigmatic long-term goals of the cancer-prevention field. For decades, prevention has been, and still is, partially fulfilled by the expansion of the practice of cervical cytology (the Pap smear), which is repeated frequently in tens of millions of asymptomatic women worldwide. The practice and the programs of cervical cytology were also instrumental in developing the concept of screening for precancerous lesions, helped in developing the methodology for program evaluation, comprehensively developed the public-health interactions between early diagnosis, clinical diagnosis, precancer treatment, cancer treatment requirements and follow-up, and provided some of the first models of cost–benefit evaluation of massive public-health interventions. Most importantly, cervical precancer screening using repeated cytology significantly contributed to the reduction of cervical cancer incidence and mortality in the areas of the developed world in which coordinated programs were implemented and sustained for extended periods of time. In these variable contexts, HPV vaccines have to find their space and integration, and decisions regarding the appropriate time to introduction is a key consideration.