Academic journal article Perspectives in Public Health

Human Papillomavirus Vaccination in Adolescence

Academic journal article Perspectives in Public Health

Human Papillomavirus Vaccination in Adolescence

Article excerpt


cervical cancer; HPV; bivalent vaccine; quadrivalent vaccine; screening programme


Cervical cancer is the third most common female cancer worldwide. It remains the highest ranking preventable cancer affecting women in developing countries. Cervical cancer is caused by sexual transmission of human papillomavirus (HPV). It is estimated that more than 80% of sexually active women will be infected with HPV in their lifetime, usually In their mid to late teens, 20s and early 30s. Persistence of high-risk oncogenic subtypes can lead to the development of precancerous change (cervical intraepithelial neoplasia (CIN)), which can ultimately lead to cervical cancer. Progression from CIN to cancer is slow in most cases, and It is believed that progression from CIN 3 to cancer at 10, 20 and 30 years Is 16%, 25% and 31.3%, respectively. The cervical screening programme has been successful In reducing the Incidence of cervical cancer by recognising early precancerous changes and treating them. A promising advance In women's health has been the development of a vaccine targeting high-risk oncogenic subtypes 16 and 18, which are responsible for 70% of all cervical cancers. Two HPV vaccines are available: Merck & Co.'s Gardasll® and GlaxoSmithKline's Cervarix®. The aim of this programme Is to provide three doses prior to sexual debut with the hope that it will reduce the rates of cervical cancer in the future. Women who are already sexually active can still be vaccinated, but, the vaccine has been shown to be less effective In them. Uptake remains a challenge for public health, and efforts should focus on educating parents about the association between HPV and cervical cancer. Routine vaccination of young men is a debatable Issue and has been found to be less cost-effective, as the burden of disease such as anal and penile cancers In males Is less than cervical cancers In women. Current evidence suggests that the HPV vaccination programme should focus on increasing and maintaining high coverage of vaccination in girls. There may, however, be some benefit in vaccinating young men in areas where the uptake of vaccination in women in less than 70%. A school-based vaccination programme has been shown to be effective, with an uptake rate In England of 76% for 2009/2010, but this has implications for the role of school nurses In the delivery of other services. This article explores the health benefits of the HPV vaccine, the impact of attitudes, cost-effectiveness and the involvement of school nurses In programme delivery.


Cancer of the cervix remains the ninth most common cancer In the United Kingdom and the third most common female cancer worldwide.1 The crude Incidence rate shows that there are approximately 11 new cervical cancers diagnosed for every 100,000 females. There are two peaks In the age-specific Incidence rates and the first, In women aged 30-34 years, Is believed to be related to women becoming sexually active In their teens and becoming Infected with human papillomavirus (HPV). The second peak occurs In women aged 80-85 years: this Is related to an Increase In cancer with age.2 There are over 100 subtypes of HPV, Including 16 high-risk types. HPV Is responsible for 99% of precancerous and cancerous lesions of the cervix. The major risk factor for cervical cancer Is persistent Infection with high-risk HPV subtypes 16 and 18. Other risk factors Include cigarette smoking, sexual activity at a young age, multiple sexual partners, socio-economic factors and HIV Infection. These all Increase the risk of a persistent Infection with HPV. The oral contraceptive pill Increases the risk of cervical cancer by reducing the likelihood that barrier contraception Is used, and via the effects of oestrogen, which supports HPV persistence. The lifetime risk of developing cervical cancer in the United Kingdom is 1 in 134 and it therefore remains a public health concern worthy of attention. …

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