Can cervical cancer be eradicated by prophylactic HPV vaccination? Challenges to vaccine implementation.

Cervical cancer is the first cancer to be shown to be 100 per cent attributable to a virus; oncogenic human papillomaviruses (HPV), particularly types 16 and 18, collectively worldwide contribute to 70 per cent squamous cell carcinomas, 85 per cent of adenocarcinomas. Cervical cancer is the second commonest cancer of women, yet largely preventable with high-quality, well-organized screening of the appropriate population. Screening programmes are either nonexistent, or function opportunistically in many poorer countries, resulting in high incidence and mortality. Recently developed, prophylactic HPV vaccines against HPV 16, 18, as cervical cancer preventative vaccines, in phase 3 clinical trials have been shown, to be highly efficacious, safe and immunogenic. With the potential for cross protection against related HPV types, estimates for prevention are in the order of 75 to 80 per cent. Thus a further option exists in the battle to reduce these cancers in women. Challenges however include implementing a vaccination programme with wide coverage to the target populations to be a successful public health tool, integration and maintenance of current screening programmes where they are in existence, the need for reduced costs of the current vaccines, long-term immunogenicity (will there be a need for further doses?), appropriate education messages to the general community, governments, as well as the medical profession.