What are the preventive measures for cervical cancer?

Preventive Measures for Cervical Cancer

Cervical cancer prevention relies on two pillars: HPV vaccination starting at ages 11-12 years and regular screening beginning at age 25 years with primary HPV testing every 5 years (or age 21 with cytology if HPV testing unavailable). 1

Primary Prevention: HPV Vaccination

Vaccination Recommendations

• Routine HPV vaccination should be administered to females aged 11-12 years, with vaccination acceptable starting as young as age 9 years 1
• Catch-up vaccination is recommended for females aged 13-18 years who missed the initial vaccination series 1
• HPV vaccines prevent more than 70% of cervical cancers by targeting HPV types 16 and 18, which cause approximately two-thirds of all cervical cancers worldwide 1, 2

Available Vaccines

Three HPV vaccines provide comprehensive protection 1:

• Bivalent vaccine (2vHPV): Protects against HPV 16 and 18 with cross-protection against types 31 and 45 1
• Quadrivalent vaccine (4vHPV): Covers HPV 16,18,6, and 11 (the latter two prevent 90% of genital warts) 1
• Nine-valent vaccine (9vHPV): Includes HPV 16,18,6,11, plus five additional oncogenic types (31,33,45,52,58), potentially preventing an additional 15% of HPV-related cancers 1

Critical Vaccination Considerations

• Vaccination is most effective when administered before sexual debut, as benefit diminishes with increasing number of lifetime sexual partners 1
• HPV vaccination at ages 9-12 years will likely prevent more than 90% of cervical precancers and cancers 3
• Population-level benefits appear as early as 3 years after program implementation, including decreased high-grade cervical abnormalities and reduced prevalence of vaccine HPV types 1

Secondary Prevention: Screening

Age-Based Screening Algorithm

Ages 21-24 years:

• Begin screening at age 21 years with cytology alone every 3 years 1
• Do not screen women under age 21 regardless of sexual history or other risk factors 1
• HPV testing should NOT be used in this age group due to high prevalence of transient infections 1

Ages 25-65 years:

• Preferred strategy: Primary HPV testing every 5 years 1
• Alternative acceptable options when primary HPV testing unavailable 1:
  • Cytology alone every 3 years
  • Co-testing (HPV + cytology) every 5 years for ages 30-65 years

Age 65+ years:

• Screening may cease at age 65 with adequate prior negative screening and no history of CIN2+ in the past 25 years 1

Screening Test Performance

• HPV testing demonstrates 90% sensitivity for detecting precancer, with less than 0.15% risk of precancer over 5 years following a negative result 3
• HPV-based screening provides 60-70% greater protection against invasive cervical cancer compared to cytology-based screening alone 1
• Traditional Pap cytology has significant limitations with sensitivity less than 50% 1

Critical Implementation Points

What NOT to Do

• Never screen annually by any method - annual screening provides minimal additional benefit while dramatically increasing harms from unnecessary procedures 1
• Do not perform HPV testing before vaccination - it is not recommended and provides no clinical benefit 1
• Do not discontinue screening in vaccinated women - screening must continue regardless of vaccination status 1

Common Pitfalls to Avoid

Screening adolescents under age 21:

• Cervical cancer is extremely rare in this age group and screening leads to overtreatment of lesions with high spontaneous regression rates 1
• This overtreatment increases risk of reproductive complications including preterm delivery 1

Using HPV testing in women under age 25-30:

• High prevalence of transient HPV infections in younger women leads to excessive false positives and unnecessary interventions 1

Screening too frequently:

• The long natural history of cervical cancer progression (many years from infection to cancer) makes frequent screening inefficient and harmful 1

Access and Equity Considerations

Public health efforts must ensure vaccine access for high-risk populations 1:

• Females of color
• Immigrants and those in rural areas
• Low-income and uninsured individuals
• Those with limited healthcare access

Maximize vaccination adherence by 1:

• Co-administering with other adolescent vaccines when safety data permits
• Utilizing non-comprehensive visits (sports physicals, minor illness visits)
• Employing alternative vaccination sites for adolescents unable to access comprehensive care

Special Populations Requiring Different Approaches

These guidelines apply to average-risk individuals. More intensive screening is required for 1:

• Women with history of cervical cancer
• Those exposed in utero to diethylstilbestrol (DES)
• Immunocompromised individuals (including HIV infection)

Education Requirements

Critical educational needs exist for 1:

• Healthcare providers regarding updated screening and vaccination guidelines
• Parents and adolescents about cervical cancer prevention
• Young women about the continued necessity of screening even after vaccination
• Policy-makers to support comprehensive prevention programs