HPV Vaccination for the Prevention of Cervical Intraepithelial Neoplasia

• Published in: The New England journal of medicine Vol. 361; no. 3; pp. 271 - 278
• Main Author: Kahn, Jessica A
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 16.07.2009
• Subjects: Adolescent; Biological and medical sciences; Cervical cancer; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - prevention & control; Cervical Intraepithelial Neoplasia - virology; Clinical outcomes; Female; Female genital diseases; General aspects; Gynecology. Andrology. Obstetrics; Human papillomavirus; Humans; Immunization; Life cycles; Medical sciences; Papillomaviridae - growth & development; Papillomavirus Infections - complications; Papillomavirus Infections - prevention & control; Papillomavirus Vaccines - adverse effects; Papillomavirus Vaccines - immunology; Practice Guidelines as Topic; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Tumors; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - prevention & control; Uterine Cervical Neoplasms - virology; Womens health; Premalignant lesion; Vaccination; Papovaviridae; Female genital diseases; Papillomavirus; Virus; Medicine; Prevention; Immunoprophylaxis; Human papillomavirus; Cervical dysplasia; Cervical intraepithelial neoplasia; Uterine cervix diseases
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMct0806938

A sexually active 18-year-old woman presents to her internist for an annual examination and asks whether she should receive the human papillomavirus (HPV) vaccine. HPV causes cervical cancer. Currently available vaccines provide protection against some but not all oncogenic genotypes of the virus if the recipient has not previously been infected. Regular cervical-cancer screening is still required for vaccine recipients. A sexually active 18-year-old woman presents to her internist for an annual examination and asks whether she should receive the HPV vaccine. Currently available vaccines provide protection against some but not all oncogenic genotypes of the virus if the recipient has not previously been infected. Foreword This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author's clinical recommendations. Stage A sexually active 18-year-old woman presents to her internist for an annual examination. During the review of her family history, she notes that her mother recently received a diagnosis of “pre–cervical cancer” and underwent a loop electrosurgical excision procedure. The patient's mother has advised her to get the “cervical-cancer shot.” Should this patient receive a human papillomavirus (HPV) vaccine, and how effective would vaccination be in preventing cervical cancer? The Clinical Problem Genital HPV infection is usually acquired through sexual contact and is extremely common. In a nationally representative study of women in the United States, 25% of persons . . .