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Infectious Agents and Cancer

, 8:21

HPV Prevention

Abstract

Pap screening combined with loop electrosurgical excision procedures LEEP is almost 100% effective in preventing cervical cancer mortality yet many countries with these procedures have now implemented broad HPV vaccination programs. HPV vaccines have not been demonstrated to be more effective or safer than Pap screening in the prevention of cervical cancer and Pap screening will still be required even in vaccinated women. The HPV vaccine costs Au$450 per person and it does not protect against ~30% of cancer. This investigation analyses the cost-effectiveness of using the HPV vaccine in countries where Pap screening and surgical procedures have already reduced cervical cancer mortality to very low rates. Cost-effectiveness of vaccination programs is being determined by mathematical models which are founded on many assumptions. It is necessary to examine the rigor of these assumptions to be certain of the health benefits that are predicted. In 2002 scientists concluded that HPV 16 and 18 were the central and independent cause of most cervical cancer. This conclusion was based on molecular technology. If HPV 16 and 18 infections are the central and independent cause of most cervical cancer then the incidence of HPV 16 and 18 should vary with the incidence and mortality of cervical cancer worldwide. This correlation does not exist. It is also observed that the majority of HPV 16-18 infections do not lead to cervical cancer. This indicates that other etiological or ‘risk’ factors are necessary for persistent HPV infection to progress to cancer. The benefits of HPV vaccines have been determined by using pre-cancerous lesions in young women as a surrogate for cervical cancer. This surrogate is found to be inadequate as an end-point for cervical cancer. Clinical trials have only provided speculative benefits for the efficacy of HPV vaccines against cancer and the long-term risks of the vaccine have not been established. Pap screening will still be required in vaccinated women hence HPV vaccination programs are not cost-effective, and may do more harm than good, in countries where regular Pap screening and surgery has already reduced the burden of this disease.

KeywordsCervical cancer Human papillomavirus virus HPV Genotype Infectious diseases Gardasil® Public health policy Vaccination programs AbbreviationsHPVHuman papillomavirus

SCCSquamous cell cervical cancer

CACCervical adenocarcinoma

AISAdenocarcinoma in situ

HSILHigh-grade squamous intraepithelial lesions

WHOWorld Health Organisation

IARCInternational Agency for Research on Cancer

PCRPolymerase chain reaction

USUnited States

CDCCentre for disease control and prevention

VAERSVaccine adverse event reporting system

CECost-effectiveness

CERCost-effectiveness ratio.

Electronic supplementary materialThe online version of this article doi:10.1186-1750-9378-8-21 contains supplementary material, which is available to authorized users.

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Autor: Judy Wilyman

Fuente: https://link.springer.com/







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