DÄ internationalArchive8/2009Early Detection of Cervical Carcinomas – Finding an Overall Approach: In reply

Correspondence

Early Detection of Cervical Carcinomas – Finding an Overall Approach: In reply

Dtsch Arztebl Int 2009; 106(8): 134. DOI: 10.3238/arztebl.2009.0134b

Klug, S J

LNSLNS In Germany, women can decide freely whether to participate in cervical screening or not. If they decide against participation, then possibly present precancerous lesions on the cervix may go unnoticed and may develop into invasive cervical cancer. This is the case for vaccinated and unvaccinated women, since the currently available vaccines do not protect against all cervical cancers.

In order to achieve complete protection against cervical cancer for all women, the vaccine would need to contain all of the at least 13 different carcinogenic HPV types, and the vaccination rate in the population would need to be very high. It is currently not known for how long the vaccine confers protection and whether booster injections are required in order to confer lifelong protection. Further, it has thus far not been shown that HPV vaccination really does result in a reduced incidence of cervical cancer, even if this is a valid assumption on the basis of what is currently known about the pathogenesis.

Furthermore, if infection with one of the HPV types contained in the vaccine occurred before vaccination, the vaccination is not effective with regard to this particular type. For this reason, currently vaccinated women should continue to participate in cervical screening (1). Even if the entire female population was vaccinated the current vaccines would prevent only a maximum of 70% of all cervical cancers. Very high vaccination rates are unlikely to be achieved in the short and medium term. Future vaccines that contain more HPV types are expected to offer greater protection, but these are still under development. In the current situatio n, cervical cancer screening should be improved into an organized program with systematic invitations to participate, quality assurance, documentation, and evaluation. This is standard in many countries and has been recommended in Europe (2). DOI: 10.3238/arztebl.2009.0134b


Priv.-Doz. Dr. med. Nicolas Wentzensen
Pathologisches Institut
Abteilung für angewandte Tumorbiologie
Universität Heidelberg

Priv.-Doz. Dr. rer. nat. et med. habil. Stefanie J. Klug, MPH
Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI)
Universitätsmedizin der Johannes Gutenberg-Universität Mainz
Obere Zahlbacher Str. 69
55101 Mainz, Germany
klug@imbei.uni-mainz.de

Conflict of interest statement
PD Dr Klug advises Cytyc with regard to the conduct of the Rhine-Saar study.
1.
Raffle AE: Challenges of implementing human papillomavirus (HPV) vaccination policy. BMJ 2007; 335: 375–7. MEDLINE
2.
European guidelines for quality assurance in cervical cancer screening. Second Edition. European Commission 2008.
3.
Wentzensen N, Klug SJ: Early detection of cervical carcinomas [Früherkennung des Zervixkarzinoms – Suche nach einem Gesamtkonzept]. Dtsch Arztebl Int 2008; 105(37): 617–22. VOLLTEXT
1. Raffle AE: Challenges of implementing human papillomavirus (HPV) vaccination policy. BMJ 2007; 335: 375–7. MEDLINE
2. European guidelines for quality assurance in cervical cancer screening. Second Edition. European Commission 2008.
3. Wentzensen N, Klug SJ: Early detection of cervical carcinomas [Früherkennung des Zervixkarzinoms – Suche nach einem Gesamtkonzept]. Dtsch Arztebl Int 2008; 105(37): 617–22. VOLLTEXT