Vaccine studies have been summarized in a Cochrane review,11 showing that vaccination is highly effective for prevention of cervical dysplasia, especially when given to young girls and womena previously unexposed to the virus. It has not been fully established how long protection lasts, but vaccination appears to be 70% to 90% effective for ≥ 10 years.
Dosing schedule. The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommends a 2-dose schedule 6 to 15 months apart, for both girls and boys between 9 and 14 years of age.12 A third dose is indicated if the first and second doses were given less than 5 months apart, or the person is older than 15 years or is immunocompromised. No recommendation has been made for revaccination after the primary series.
In 2018, the US Food and Drug Administration approved Gardasil 9 for adults 27 to 45 years of age. In June 2019, ACIP recommended vaccination for mena as old as 26 years, and adopted a recommendation that unvaccinated men and women between 27 and 45 years discuss HPV vaccination with their physician.13
The adolescent HPV vaccination rate varies by state; however, all states lag behind the CDC’s Healthy People 2020 goal of 80%.14 Barriers to vaccination include cost, infrastructure limitations, and social stigma.
Secondary prevention: Screening and Tx of precancerous lesions
Cervical cancer screening identifies patients at increased risk of cervical cancer and reassures the great majority of them that their risk of cervical cancer is very low. There are 3 general approaches to cervical cancer screening:
cytology-based screening, which has been implemented for decades in many countries
primary testing for DNA or RNA markers of high-risk HPV types
co-testing with cytology-based screening plus HPV testing.
