CERVICAL CANCER SCREENING AND VACCINATION

Cervical cancer remains one of the leading causes of female mortality globally, affecting almost half a million women every year.
While the overall mortality rate has significantly decreased in high-income countries during the last decades, it remains high in middle- and low-income countries, with 88% of deaths.
The most prevalent risk factors for cervical cancer include infection with human papillomavirus (HPV) , infection with Human Immunodeficiency Virus (HIV) or other causes of immunosuppression , in utero exposure to diethylstilbestrol (DES) and a previous history of precancerous cervical lesions, such as cervical intraepithelial neoplasia (CIN) grade 2 or 3.
Screening for cervical cancer aims primarily at the detection of precancerous lesions to prevent their progression to invasive disease; cytology was the most commonly used method.
The development and implementation of effective vaccines against high-risk HPV subtypes, especially 16 and 18, have significantly reduced HPV-related precancerous lesions
However, while this is a highly effective strategy to drastically reduce the incidence of cervical cancer, implementation still remains at a suboptimal level, especially in low-income countries.

SOME IMPORTANT SCREENING RECOMMENDATIONS

ASCO	WHO
SCREENING METHODS	HPV testing -VIA	-HPV testing -VIA -Cytology
AGES <21	Screening not recommended	Screening not recommended
AGES 21–29	Age 21–24 years → Screening not recommended Age >25 years → Maximal: HPV testing every 5 years Enhanced: screening not recommended Limited: screening not recommended Basic: Screening is not recommended	Screening not recommended
AGES 30–65	Maximal: HPV testing every 5 years Enhanced: HPV testing every 5 years or every 10 years after two consecutive negative results Ages 30–49 → Limited: HPV testing every 10 years Basic: HPV testing every 10 years or VIA every 5–10 years	Age 30–50 Primary HPV testing with or without HPV 16/18 genotyping every 5– 10 years Alternatively: -VIA every 3 years -Cytology every 3 years Age 50–65 Screening may be offered in women with no screening history if feasible

AGES >65	Maximal: individualization, screening up to 70 years Enhanced: Screening is not recommended if adequate previous screening Limited: screening not recommended Basic: screening is not recommended	Screening not recommended
ADEQUATE SCREENING	Maximal: negative results in the last 15 years Enhanced: negative results in the last 15 years	2 consecutive negativeresults
HISTORY OFPRECANCEROUSLESION	Maximal: If (+) at 60 years, screening for at least 10 years	In CIN2/3: Repeat HPV DNA in 12 months If negative, routine screening In CIN3+: HPV DNA annually for 3 years after treatment and then return to routine screening
HISTORY OFHYSTERECTOMYWITHOUT PREVIOUSCIN2/3	Screening not recommended	Not mentioned
ABNORMAL RESULTS	Enhanced: In HPV DNA (+) → hrHPV and/or cytology In negative results → repeat HPV in 12 months In positive results → colposcopy Limited: In HPV DNA (+) → Cytology or hrHPV or VIA Abnormal cytology → colposcopy or	If negative → repeat HPV at 24 months (if negative, routine screening) In primary cytology (+) and colposcopy (-) → HPV DNA at 12 months (if negative, routine screening)

	VAT Basic: In HPV DNA (+) → VAT
IMMUNODEFICIENCY	Twice as many screenings as the general population	If negative → repeat HPV at 12 months (if negative, routine screening) In primary cytology (+) and colposcopy (-) → HPV DNA at 12 months (if negative, routine screening) If treated for CIN2+ → two consecutive negative HPV DNA results every 12 months before routine screening
VACCINATION	Same screening	Not mentioned
PREGNANCY	Not mentioned	Not mentioned
SEXUAL ACTIVITY	Not mentioned	Not mentioned

*hr- HIGH RISK

WHO now recommends:

GARDASIL 9 helps protect individuals ages 9 to 45 against the following diseases caused by 9 types of HPV STRAINS: cervical, vaginal, and vulvar cancers in females, anal cancer, certain head and neck cancers, such as throat and back of mouth cancers and genital warts in both males and females.

For persons 9 through 14 years of age, GARDASIL 9 can be given using a 2-dose or 3-dose schedule.
For the 2-dose schedule, the second shot should be given 6-12 months after the first shot. If the second shot is given less than 5 months after the first shot, a third shot should be given at least 4 months after the second shot.
For the 3-dose schedule, the second shot should be given 2 months after the first shot and the third shot should be given 6 months after the first shot.
For persons 15 through 45 years of age, GARDASIL 9 is given using a 3-dose schedule; the second shot should be given 2 months after the first shot and the third shot should be given 6 months after the first shot.

INDICATION:

CERVAVAC is indicated in girls and women 9 through 26 years of age for the prevention of the following diseases caused by Human Papillomavirus (HPV) types, included in the vaccine:

CERVAVAC is indicated in boys and men 9 through 26 years of age for the prevention of the following diseases caused by HPV types included in the vaccine:

CERVAVAC should be administered intramuscularly in the deltoid region of the upper arm or in the higher anterolateral area of the thigh.

Individuals 9 to 14 years of age:

CERVAVAC should be administered according to a 2-dose schedule (0.5 ml at 0, 6 months).
Individuals 15 to 26 years of age CERVAVAC should be administered according to a 3-dose (0.5 ml at 0, 2, 6 months) schedule.
The second dose should be administered at least one month after the first dose and the third dose should be administered at least 3 months after the second dose. All three doses should be given within a 1-year period.

The safety and efficacy of CERVAVAC in children below 9 years of age have not been established. No data are available.
It is recommended that individuals who receive a first dose of CERVAVAC complete the vaccination course with CERVAVAC.
The need for a booster dose has not been established.