Who should be targeted for vaccination against anal cancer?

Department of Obstetrics and Gynecology, Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Lee's Summit Road, Kansas City, MO 64139, USA.
The Lancet Oncology (Impact Factor: 24.69). 08/2011; 12(9):828-9. DOI: 10.1016/S1470-2045(11)70237-6
Source: PubMed
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    ABSTRACT: The dominant HPV-associated disease is cervical cancer. In the US, 88% of the diagnoses and 92% of the costs pertain to controlling cervical cancer and its screening program. Secondary prevention has worked extremely well at reducing the overall incidence of cervical cancer to 8.3/100,000 women, with only black and Hispanic women having incidences of cervical cancer above the national average at 11.1 and 12.8/100,000 respectively. Gardasil has market dominance in the US. Gardasil is able to reduce the incidence of cervical cancer at its maximal performance to 14/100,000, while Cervarix is able to reduce the incidence to 9.5/100,000. Gardasil will not lower the population-based cervical cancer incidence rate in the US, but may contribute to a lowering of the rate of abnormal Pap tests, colposcopies and treatments for pre-invasive disease. Recent data indicates that Gardasil may offer protection to heterosexual men for the prevention of genital warts and to men who have sex with men (MSM) for the prevention of anal dysplasia caused by HPV 6/11. A summary table of the populations and efficacies is presented for all populations studied.
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    ABSTRACT: Renal transplantations (RTs) are performed routinely in many countries. After RT, the administration of lifelong immunosuppressive therapy is required. As a consequence, renal transplant recipients (RTRs) have a high risk to develop virus-associated (pre)malignancies, such as Human papillomavirus (HPV) related anogenital (pre)malignancies. It is known that the majority of the RTRs are infected with HPV and that these women have a 14-fold increased risk of cervical cancer, up to 50-fold of vulvar cancer and up to 100-fold of anal cancer. Often, treatment of these lesions requires concessions and may be suboptimal as radiation therapy and extensive surgery may damage the renal transplant. Therefore, prognosis may be compromised due to inadequately treated malignancies. Especially for these immunocompromised patients prevention is of utmost importance. Yearly cervical cancer screening for RTRs is advised, but appears to be executed poorly. For the future, optimizing screening and prevention of anogenital (pre)malignancies is an important issue for women after RT. This review gives a broad overview of all aspects regarding HPV-related (pre)malignancies of the female anogenital tract in RTRs.
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