Contents

9 Human papillomavirus (HPV)

9.8 Cancer prevention measures

For women, HPV immunisation is part of a three-pronged approach to cervical cancer prevention that also includes regular cervical screening and safer sex approaches. For men, HPV immunisation and safe sex approaches are expected to contribute to the prevention of HPV-related cancers and disease that affect men, as well as cervical cancer prevention in women.

9.8.1 HPV immunisation

A vaccine that can prevent infection with oncogenic HPV types has the potential to reduce the incidence of precursor lesions and cancer. Vaccination needs to be administered before HPV infection occurs in order to prevent atypia and malignancy. Because genital HPVs are so common and so readily transmitted, in practical terms vaccination should be offered before the onset of sexual activity, that is, during early adolescence.

HPV immunisation does not reduce the progression of established disease but can be used in therapeutic situations by preventing the reactivation of latent infection.

9.8.2 Regular cervical screening for womenTop

A successful HPV immunisation programme for men and women will reduce the community prevalence of HPV infection and thus the incidence of cervical cancer in women. However, HPV immunisation will not completely eliminate cervical cancer because some women will not have been vaccinated, a few will not develop immunity despite vaccination, and some will be infected prior to vaccination or with oncogenic types not present in the vaccine.

Consequently, women will need to continue to undergo regular cervical screening to detect those precancerous lesions that occur despite vaccination. Cervical screening programmes are based on regular cytological screening or HPV testing to detect, monitor and treat at an early stage precancerous lesions, or CIN. These programmes have been successful in reducing invasive disease and mortality.

Although the frequency of abnormal cytology is lower in the vaccinated group, women who have received HPV immunisation should still take part in the National Cervical Screening Programme. Three-yearly cervical smears are recommended for women between the ages of 20 and 70 years who have ever been sexually active.

9.8.3 Safer sex approachesTop

To minimise the risk of HPV infection (plus other sexually transmitted infections), practitioners should remind individuals of safer sex approaches, including sexual abstinence, monogamous relationships, delayed sexual debut, and minimising the number of sexual partners.2 Consistent and correct use of condoms can decrease the risk of anogenital HPV infection when infected areas are covered or protected by the condom. However, HPV transmission in the genital region may occur even when condoms are used and does not necessarily require penetrative intercourse.