Position paper--HPV and the primary prevention of cancer; improving vaccine uptake by paediatricians.

A large proportion of sexually active adults are infected with the human papillomaviruses (HPVs). Although largely asymptomatic, some types of HPVs (HPV-16, HPV-18) which infect the genitalia are known to cause cancers, including cervical cancer. Cervical cancer is an important public health concern and is the second most clinically important cancer to breast cancer in women aged 15-44 years. Until recently, cervical cancer strategies focussed on screening. However, as adolescents become sexually active at a much younger age, the focus is on the use of vaccination as an effective measure to prevent progression of HPV infection to cancer. HPV is also involved in the aetiology of cancers of the anus, vagina, vulva and penis as well as genital warts and laryngeal papillomatosis in young children. Primary prevention through vaccination is now possible in Europe using either the quadrivalent HPV vaccine, Gardasil® (Sanofi Pasteur MSD), or the bivalent HPV vaccine, Cervarix® (GSK), which are both highly immunogenic, with their effects persisting for at least 5 years. HPV vaccines are well tolerated, with serious vaccine-related events occurring in less than 0.1% of patients for both vaccines. Here, we review the possibilities for utilising vaccination programmes alongside current cervical cancer screening in comprehensive cervical cancer prevention programmes. The European Academy of Paediatrics Scientific Working Group on Vaccination concluded that the use of HPV vaccines will have a significant impact in primary prevention of cancers and other HPV-related disease.