Prevention of Cervical Cancer

Abstract

Cervical cancer is the fourth most common cancer in women and is responsible for 275,000 deaths worldwide each year. The burden of this disease lies in the developing world. However it is arguably the most preventable cancer. The Human Papilloma Virus (HPV) is responsible for almost all cases of Cervical Cancer. HPV is sexually transmitted and has a lifetime cumulative risk of infection of 80%. National Cervical cytology screening programmes are used to detect cervical abnormalities, lesions and early cancers in as many eligible women as possible, saving lives and reducing morbidity. However uptake of screening is declining, and screening programmes have not been implemented in lower resource countries due to the cost and infrastructure required. Alternative screening methods have been implemented in such countries such as Visual Inspection with Acetic acid (VIA) but mortality and morbidity remain high. Since 2007, programmes of vaccination against the most oncogenic types of HPV have been rolled out internationally aiming to capture girls, and eventually potentially boys, before they become sexually active. These programmes have been largely successful, with good coverage and low adverse effects reported. Going forward, the vaccine and the advent of effective HPV screening and self testing mean that there needs to be a reorganisation of current cervical screening programmes.