Primary and Secondary Prevention of Cervical Cancer—Opportunities and Challenges

Extract

Two prophylactic human papillomavirus (HPV) vaccines have been shown to be highly effective in phase III trials ( 1 , 2 ) and are now recommended for use in many countries worldwide ( 3 , 4 ). As a result, primary prevention of cervical cancers that are attributable to HPV types 16 and 18 is now possible. Although this prospect has been enthusiastically embraced, it brings new challenges. These challenges will differ depending on a country's health care infrastructure, cultural issues, and political will, as well as on the status of cervical cancer control in that country. In countries like the United States that have an existing strategy of cervical cancer control via screening, one challenge is that primary prevention must be integrated into that strategy ( 5 ). Another challenge is the need to develop cost-effective strategies to monitor the impact of these expensive vaccines.

The study by Wheeler et al. ( 6 ) in this issue of the Journal includes information related to both of these challenges. The authors used a case–control study design with a statewide population-based sampling strategy. Specifically, they used the New Mexico Tumor Registry to identify cases and tested the archived tissues from available invasive cervical cancer cases (1980–1999) and in situ cervical cancers from two tertiary centers (1985–1999). Their control group was drawn from the routine cervical cancer screening population at the same two centers that served as the source of the in situ cases (1996–2000). The authors reasoned that the screening population would give a more accurate representation of the HPV type distribution in the at-risk population than would age-matched control subjects. The authors provide important details on tissue block retrieval and selection that give only a hint of the logistical problems that must be solved to attempt such a comprehensive analysis. What did we learn from this study to date (because the authors clearly have more information and analyses pending)?