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Feature Article

Cervical cancer prevention in the HPV era

Gerard Wain

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Abstract

As understanding of the role of HPV in the development of cervical cancer increases, we are entering a new era in disease prevention.

Key Points

  • The causal role of HPV in all cancers of the cervix has been firmly established. However, although infection with HPV is very common, cervical cancer is a rare outcome from HPV infection.
  • Most HPV infections clear spontaneously. Persistent infection with a high risk type is necessary to establish malignant transformation of the cervix.
  • Clinical trials of Gardasil – the HPV vaccine now licensed for clinical use in Australia – have shown it to be highly effective at preventing infection with two high risk types of HPV and at preventing the precursor cervical lesions associated with persistent HPV infection.
  • The development of clinical management protocols matched to the natural history of cervical cancer and the availability of a vaccine are key features in a new era of disease prevention.
  • Women treated for high grade lesions of the cervix are at increased risk of further high grade disease and cancer. HPV testing is now incorporated into the follow up of such women.
  • Women with clinical symptoms of cervical cancer should be referred for investigation regardless of their Pap test result.

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