By P. DaviesArticle first published online: 16 MAY 2012 DOI: 10.1111/j.1365-2303.2012.00984.x © 2012 Blackwell Publishing Ltd
Population-based, organized screening programmes can reduce cervical cancer rates by 80%,1 although this will only be achieved with high coverage of the target population.2–4 The introduction of vaccines protecting against oncogenic human papillomavirus (HPV) types 16 and 18 has provided a valuable additional tool for the prevention of cervical cancer,5 although the maximization of their benefits is also dependent on high coverage of the target population.6 A further consideration is that, neither of the two HPV vaccines that are currently available protect against all of the HPV types that can cause cervical cancer, so that even women who have been vaccinated must still be screened to prevent cancers arising from other types.7 As a result, the anticipated benefits of adding HPV vaccination to cervical cancer prevention programmes will be reduced or even reversed if vaccinated women fail to attend for screening from a mistaken belief that they are fully protected against cervical cancer.6–11
The UK, in common with some other countries, recognized this potential problem and launched an extensive public health education programme before the implementation of HPV vaccination in September 2008, although the main focus of this programme was to ensure broad acceptance of HPV vaccination, which is not necessarily the same thing as ensuring a broad understanding of the issues. Subsequently, Henderson et al.12 interviewed British girls who had been offered HPV vaccination, together with their parents, finding a lack of understanding about (1) the level of protection offered by the vaccines and (2) the ongoing need for cervical cancer screening irrespective of vaccination status. This does not look encouraging for the participation of these girls in cervical screening programmes when they reach screening age.