Paradigm shift needed for cervical cancer: HPV infection is the real epidemic

Abstract

In South Africa (SA) the prevalence of cervical cancer is alarmingly high, presentation is late and survival rates are poor. High-risk human papillomavirus (hrHPV) has been established as a prerequisite for the development of cervical cancer, and prevention programmes in many developed countries include primary prevention through immunisation against types 16 and 18 before hrHPV exposure. Two articles in this issue of SAMJ report the outcome of a vaccine demonstration project in rural KwaZulu-Natal (KZN), and high hrHPV prevalence among a large sample of SA women. The editorial discusses optimal cervical cancer prevention programme for a middle-resourced country with an extremely high burden of HPV-associated disease like SA, and proposes initiation of primary school-based HPV vaccination as soon as possible, 10-yearly HPV-based screening, and effective treatment of women with positive screening tests.