Article

HPV vaccination for the prevention of cervical intraepithelial neoplasia.

Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
New England Journal of Medicine (Impact Factor: 54.42). 08/2009; 361(3):271-8. DOI: 10.1056/NEJMct0806938
Source: PubMed

ABSTRACT A sexually active 18-year-old woman presents to her internist for an annual examina- tion. During the review of her family history, she notes that her mother recently re- ceived a diagnosis of "pre-cervical cancer" and underwent a loop electrosurgical exci- sion procedure. The patient's mother has advised her to get the "cervical-cancer shot." Should this patient receive a human papillomavirus (HPV) vaccine, and how effective would vaccination be in preventing cervical cancer? The Clinical Problem Genital HPV infection is usually acquired through sexual contact and is extremely common. In a nationally representative study of women in the United States, 25% of persons between the ages of 14 and 19 years and 45% of persons between the ages of 20 and 24 years were HPV-positive.1 It is estimated that more than 80% of both men and women in the United States will be infected with HPV at some point in their lives.2 HPV is often acquired within months after the first sexual intercourse: in a study of university women who had recently had sexual intercourse for the first time and reported having only one partner, almost 30% became HPV-positive within 1 year.3 Although HPV infection is usually asymptomatic, anogenital warts or can- cers or other HPV-associated cancers develop in a subgroup of infected women and men. The clinical outcome of greatest significance for public health is cervical cancer. Globally, cervical cancer is the second most frequent cancer among women; each year, approximately 490,000 women receive this diagnosis and 270,000 die from cervical cancer.4 In the United States, the implementation of cytologic screening programs with the Papanicolaou (Pap) test has led to a decrease in rates of cervical cancer, since screening identifies precancerous cervical lesions that can be treated before they prog- ress to cancer. Despite such screening, in 2008, approximately 11,000 women in the United States received a diagnosis of cervical cancer and 3900 died from the disease.5 The direct medical costs associated with the prevention and treatment of HPV- related anogenital warts and cervical disease in the United States are estimated to be $4.0 billion annually,6 and productivity losses due to deaths from cervical can- cer are estimated to be $1.3 billion annually.7

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