Combining HPV vaccination with screening to prevent cervical cancer

While the latest findings on long-term efficacy of the HPV vaccine are cause for celebration, vaccinations should be coupled with preventive screening to better protect women from cervical cancer, two University of Michigan experts argue in an invited commentary in The Lancet’s EClinicalMedicine journal.

In the commentary, Diane M. Harper M.D., M.P.H., a professor in the departments of family medicine, obstetrics and gynecology, and women’s studies, and Sherri Sheinfeld Gorin, Ph.D., an adjunct research professor in the Department of Family Medicine, respond to a final report detailing the long-term efficacy of the quadrivalent HPV vaccine, marketed as Gardasil. The study found the vaccine to be completely effective in preventing HPV infections type 16 and 18 for more than 10 years after final dosing. Harper and Sheinfeld Gorin temper these findings with a call for combined HPV vaccination and screening.

“The risk of HPV infections is lifelong,” Harper and Sheinfeld Gorin write.

“The vaccines cannot protect against all types that cause cancer. Vaccines or screenings alone only offer partial solutions. This means that we need two weapons to control cervical cancer: screening and vaccination,” Harper adds.

Separately, vaccination and screening only provide partial protection against cervical cancer. Moreover, economic and social factors make it difficult to achieve 100% adoption of either method.

The most current FDA-approved HPV vaccine, marketed as Gardasil 9, costs upwards of $227.93 per dose at private sector cost, and requires two to three doses. With a Centers for Disease Control and Prevention contract, the price is lower — at $187.01 per dose. Still, the authors note that it is the most expensive prophylactic vaccine listed by the CDC’s June 2020 vaccine price list.

Historically, cervical cancer screening has required routine Pap smears with a health care provider, although recently, the US Preventive Services Task Force indicated that screening by HPV testing results in the most life years gained for women 30-65 years old.

“Primary HPV screening can be done by the woman herself, adding a dimension of empowerment for cancer control that could also decrease the overall cost,” Harper and Sheinfeld Gorin note.

“It is an exciting time when research comes together for the benefit of the woman, allowing HPV vaccination to bridge her protection until she is of age for screening and then potentially screening at home.”

Harper is an internationally recognized clinical research expert in HPV-associated diseases, their prevention, early detection, and treatment to prevent cancer. She has led landmark randomized controlled trials of the bivalent and quadrivalent prophylactic HPV vaccines, with results published in the New England Journal of Medicine, The Lancet, and The Lancet Oncology, as well as sentinel research on therapeutic vaccinations against CIN 3 lesions caused by HPV 16/18 published in Gyn Oncology. She is also a former member of the U.S. Preventive Services Task Force and serves as senior associate director of the Michigan Institute for Clinical and Health Research.

“Both vaccination and screening must be applied across the lifespan. Together primary and secondary preventions are powerful; alone they offer partial solutions,” Harper says.

Citation: Harper DM, Sheinfeld Gorin S., “HPV vaccination bridges to HPV screening.” The Lancet EClinicalMedicine. DOI: 10.1016/j.eclinm.2020.100435

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