Prospects for primary prevention of cervical cancer in developing countries

Résumé 0

"The HPV types that cause cervical cancer are sexually transmitted,but there is little evidence that infection can be avoidedby behavioural changes, such as condom use. In contrast,prophylactic vaccines against HPV infection are likely to havehigh efficacy. In principle, the effectiveness of HPV vaccinationas a strategy for cervical cancer control can be measuredeither by monitoring secular trends in cervical cancer incidenceor by conducting randomized trials. The former approachis unlikely to provide convincing evidence of effectiveness,since cervical cancer rates are subject to strong seculartrends that are independent of intervention measures. Afew phase III trials of HPV prophylactic vaccines are nowbeing started. Such trials are very expensive studies involvingfrequent and complicated investigations. It is important,however, to start as soon as possible simpler trials designedto demonstrate the effectiveness of HPV vaccine in fieldconditions, i.e. in developing or intermediate countries whichsuffer the major burden of mortality from cervical cancer.Such trials may capture a difference in the most severe, andrarest, preinvasive cervical lesions (i.e., the real target ofany HPV vaccine) over a prolonged follow-up (20 years atleast). The design of such studies is briefly considered fortwo areas: Southern India and South Korea. This paper isavailable at: http://www.insp.mx/salud/index.html"