Clinical role of cervical cancer vaccination: When and whom to vaccinate? Aureli Torné ⁎ , Immaculada Alonso, Luis M. Puig-Tintoré, Jaume Pahisa Department of Gynecologic Oncology, Hospital Clinic, University of Barcelona, Barcelona, Spain Received 9 June 2008 Available online 17 July 2008 Abstract The recent development of two highly effective vaccines against persistent infection by the 2 most important types of human papillomavirus (HPV) (16 and 18) and against high grade premalignant lesions (CIN2+) has opened a new scenario for the primary prevention of cervical cancer. The optimum target population for vaccination should be individually defined taking the following into account: 1) the efficacy of the vaccine, 2) the epidemiological context and 3) the vaccination programs available in each country. To achieve the maximum preventive benefits, the vaccine should be administered before the initiation of sexual relations. So, the HPV vaccine should be integrated in the school vaccination programs of adolescents together with other vaccines. The vaccination of sexually active women may considerably increase the speed with which results in the fight against this disease will be achieved. Developed countries will probably consider the vaccination of these women, although vaccination strategies and the efforts to reach this population will be conditioned by the resources of each country and by the estimations of the cost-efficacy relationship in each situation. Women with a previous history of premalignant cervical disease or with an abnormal screening test should not be excluded from the potential benefits which the vaccine may provide. There is no contraindication for the administration of the vaccine in immunosupressed women. However, it is still unknown under what specific circumstances of immunosuppression the immunogenicity of the vaccine may be affected and there are currently ongoing studies for an answer to this question. © 2008 Elsevier Inc. All rights reserved. Secondary prevention of cervical cancer by Pap smear has notably reduced the incidence of and mortality from this disease. However, cervical cancer and its precursor lesions continue to represent an important social and health care burden, even in the most developed countries. In developed countries, the accumulated lifetime risk (0–64 years) of cervical cancer is 1 out of every 125 women. Even in European countries with a very low incidence of the disease (such as Spain), cervical cancer is the second most frequent cancer among women 15–44 years of age [1]. The recent development of two highly effective vaccines targeting persistent infection by the 2 most important types of human papillomavirus (HPV 16 and 18) and against high- grade premalignant lesions (cervical intraepithelial neoplasia, [CIN]2+) offers new hope for the primary prevention of cervical cancer. Target population for HPV vaccination The optimum target population for HPV vaccination should be individually defined and account for the following: (1) efficacy of the vaccine; (2) epidemiological context (prevalence of the HPV infection, age at onset of sexual relations); and (3) vaccination programs available in each country. Current knowledge allows confirmation only of the prophylactic nature of the vaccine, rather than of any potential therapeutic effect [2]. Cervical cancer may occur in vaccinated women because of a previous infection by the HPV type included in the vaccine or by infection by another HR-HPV type that is not included. Therefore, to achieve the maximum preventive benefits, the vaccine should be administered before the initiation of sexual relations. The risk of infection by HR-HPV is especially high among sexually active adolescents (most women are infected with at least one type of HR-HPV 2–5 years from initiation of sexual activity). The prevalence of HPV in sexually active adolescents Available online at www.sciencedirect.com Gynecologic Oncology 110 (2008) S15 – S16 www.elsevier.com/locate/ygyno ⁎ Corresponding author. Fax: +34 93 227 9325. E-mail address: aureli@comb.es (A. Torné). 0090-8258/$ - see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.ygyno.2008.06.015