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Age-appropriate use of human papillomavirus vaccines in the US
Gynecologic Oncology, 06/30/09

Castle PE et al. - In a review of age-appropriate use of human papillomavirus (HPV) vaccines in the US, it was concluded that prophylactic HPV vaccines will provide the greatest public health or population benefit only when delivered to adolescent, mostly HPV-naive women.

Methods

Cervical infections by approximately 15 cancer-associated (carcinogenic) HPV genotypes cause virtually all cervical cancer and its immediate precursor lesions worldwide.
Prophylactic vaccines against HPV types HPV16 and HP18, which cause 70% of cervical cancer worldwide, hold great promise for reducing the burden of cervical cancer worldwide.
Current HPV vaccines prevent future infections and related cervical abnormalities and do not treat pre-existing HPV infections.

Results

In the US, HPV vaccine introduction should be considered in the context of a very successful cervical cancer screening program that has reduced rates of cervical cancer by 75% or more.
HPV vaccines will only prevent an incremental number of additional cervical cancers in the US.
Introduction of HPV vaccines can also prevent other HPV-related sequelae, most importantly cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3), which precede development of cervical cancer and require clinical follow-up and treatment.
Examining data from 7 clinical centers in the US, median age of CIN2/3 is typically between 25 and 30 yrs of age in 2007; if screen-detected CIN2/3 develops on average 5–10 yrs after the causal infection is acquired, HPV vaccination will only prevent a significant proportion of CIN2/3 if it is given to women before age 26 and more so if given to women 18 and younger.

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