Evaluating the potential benefits of universal worldwide human papillomavirus vaccination

摘要

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