The Lancet Infectious Diseases

Chris T Bauch
The Lancet Infectious Diseases, Volume 10, Issue 9, Page 595,
September 2010
doi:10.1016/S1473-3099(10)70183-3

Our Personal View1 presents a mathematical model to determine the conditions under which a decline in screening adherence in vaccinated women would outweigh the benefits of a human papillomvirus (HPV) immunisation programme, and thus result in a net increase in cervical cancer incidence. In their refutation, Diane Harper and colleagues’2 create a misrepresentation of our model and then refute that misrepresentation. First, Harper and colleagues interpret our model as showing that human papillomavirus (HPV) vaccination will prevent any future increase in incidence of cervical cancer. We find that such an increase is indeed possible, especially when screening coverage is high before vaccine introduction, however, it does not occur unless the decline in screening adherence is steep. Second, Harper and colleagues incorrectly cite the opportunistic screening scenario; for comparison to the situation in Finland, for which the organised screening scenario (high coverage) should be cited. Our model1 predicts that a rise in cervical cancer incidence in vaccinated women is more likely with organised screening than with opportunistic screening, and so data from Finland might actually validate our model.