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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe recognition that cervical cancer is caused by human papillomavirus (HPV) has opened new opportunities for preventing this devastating cancer. This article presents evidence for the feasibility of eliminating cervical cancer through combined screening and HPV vaccination.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EViral Infections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EReproductive Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESexually Transmitted Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EScreening \u0026amp; Prevention Reproductive Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EVaccinations\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe recognition that cervical cancer is caused by human papillomavirus (HPV) has opened new opportunities for preventing this devastating cancer. Jack Cuzick, PhD, Saint Bartholomew\u0027s Medical School, London, United Kingdom, presented evidence for the feasibility of eliminating cervical cancer through combined screening and HPV vaccination.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EHPV and Cytology Screening for Cervical Cancer\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ETo detect cervical cancer, European and North American screening studies have suggested primary HPV screening as a better method than traditional cytological methods. In a large pooled analysis which included 60,000 women included, HPV screening was more sensitive than cytology (96.1% vs 53%) in detecting cervical intraepithelial neoplasia grade 2 or greater (CIN2+) but less specific (90.7% vs 96.3%) [Cuzick J et al. \u003Cem\u003EInt J Cancer\u003C\/em\u003E 2006]. In a multinational cohort, the cumulative incidence of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) after 6 years was considerably lower among women negative for HPV at baseline than among women with negative cytology at baseline [Dillner J et al. \u003Cem\u003EBMJ\u003C\/em\u003E 2008]. The data support the use of HPV testing as the primary screening test for cervical cancer.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003E\n            \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E shows a proposed new screening algorithm beginning with HPV testing, followed by cytology screening for those with positive HPV results and colposcopy for patients with abnormal cytology. In the future, the algorithm may be modified and simplified by including HPV-16 typing and testing for p16 overexpression to reduce referrals for nonprogressive HPV infections.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/15\/30\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Proposed New Screening Algorithm.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-290013039\u0022 data-figure-caption=\u0022Proposed New Screening Algorithm.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/15\/30\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/15\/30\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/15\/30\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14538\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EProposed New Screening Algorithm.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECyto=cytology; HPV=human papillomavirus.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from J Cuzick, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EHPV Vaccination\u003C\/h2\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EPrimary prevention of cervical cancer is possible with HPV immunization of adolescents and young women. The Cervical Intraepithelial Neoplasm (CIN) in Women [FUTURE II; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00092534\u0026amp;atom=%2Fspmdc%2F12%2F15%2F30.atom\u0022\u003ENCT00092534\u003C\/a\u003E] trial of a quadrivalent vaccine against HPV-6\/11\/16\/18 included a per-protocol susceptible population of 5305 women in the vaccine group and 5260 women in the placebo group [FUTURE II Study Group. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007]. At 36 months median follow-up, the vaccine efficacy for preventing the composite endpoint of CIN2\u20133, adenocarcinoma in situ, or HPV16\/18-related cervical cancer was 98% (95.89% CI, 86 to 100). Nonavalent vaccines against HPV-16\/18, HPV-6\/11 (for prevention of genital warts), and 5 new oncogenic types (31, 33, 45, 52, and 58) are currently under development.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe HPV Vaccine Efficacy Trial Against Cervical Pre-cancer in Young Adults with GlaxoSmithKline (GSK) Biologicals HPV-16\/18 [PATRICIA; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00122681\u0026amp;atom=%2Fspmdc%2F12%2F15%2F30.atom\u0022\u003ENCT00122681\u003C\/a\u003E] trial randomized 18,644 women to HPV-16\/18 vaccine versus control [Lehtinen M et al. \u003Cem\u003ELancet Oncol\u003C\/em\u003E 2012]. After a mean follow-up of 44.2 months, vaccine efficacy against CIN3+ associated with HPV-16\/18 was 100% (95% CI, 85.5 to 100) in the total vaccine cohort-na\u00efve. Vaccine efficacy against all CIN3+ was 93.2% (95% CI, 78.9 to 98.7; \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/15\/30\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Vaccine Efficacy in the Total Vaccine Cohort-Na\u0026#xEF;ve.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-290013039\u0022 data-figure-caption=\u0022Vaccine Efficacy in the Total Vaccine Cohort-Na\u0026#xEF;ve.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/15\/30\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/15\/30\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/15\/30\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14540\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EVaccine Efficacy in the Total Vaccine Cohort-Na\u00efve.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003ECIN2+=cervical intraepithelial neoplasia grade 2 or greater; CIN3+=CIN grade 3 or greater; TVC=total vaccine cohort.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReprinted from Lehtinen M et al. Overall efficacy of HPV-16\/18 AS04-adjuvanted vaccine against grade 3 or greater cervical intraepithelial neoplasia: 4-year end-of-study analysis of the randomised, double-blind PATRICIA trial. \u003Cem\u003ELancet Oncology\u003C\/em\u003E;13(1):89\u201399. Copyright 2012, with permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EIssues associated with HPV vaccination include the need for 3 doses, cross-protection against other HPV types, durability of protection, the focus on adolescent girls, vaccination of boys, the need for vaccines not requiring cold storage, and lack of effectiveness after HPV infection. Vaccination coverage can be improved in the future by extending the age range for vaccination to children and adult women, and by alternative dose schedules (eg, 2 doses) [Kreimer AR et al. IPvC 2010]. Cervical cancer rates can be further reduced by screening older women to eliminate all current disease and vaccinating with polyvalent vaccines to prevent future disease. Next-generation HPV vaccines include polyvalent L1 virus-like particle (VLP) vaccines, L2 peptide vaccines, chimeric L1\/L2 VLP vaccines, and combined prophylactic and therapeutic HPV vaccination [Kanda T and Kondo K. \u003Cem\u003EHum Vaccin\u003C\/em\u003E 2009; Stanley M. \u003Cem\u003ECurr Opin Infect Dis\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003ECervical cancer is the only cancer with a single, known cause: HPV. Vaccination can prevent infection but not eliminate it or impact subsequent cancer once it occurs. Cytology screening can identify treatable precursor lesions in women who are found to have HPV infection. Prof. Cuzick concluded that combined screening and vaccination in women aged 25 through 50 years offers the best chance of eliminating cervical cancer.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/15\/30.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn8hp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn8hp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}