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PubMed1992

Care and costs for advanced cervical cancer.

The types, amounts and costs of hospital and home care in patients who died from cervical cancer are investigated, using both national data sources and hospital files. Our goal has been assessment of the savings on treatment and care of advanced cervical cancer resulting from cervical cancer screening. Hospital costs account for 70% of the total cost per patient of Dfl 29,200. The amount of hospital care decreases significantly with increasing age. The average number of days of hospitalisation per patient with advanced disease decreases from 62 days below age 50 to less than 10 days at age 70 and older. In-hospital medical procedures, home care and nursing home care account for 24, 22 and 8% of the costs, respectively. Mass screening programmes for cervical cancer will result in a reduction in both advanced disease and mortality. The potential savings compensate approximately 10% of the costs of screening.

Adult↗
PubMed1994

Antibodies against linear and conformational epitopes of the human papillomavirus (HPV) type 16 E6 and E7 oncoproteins in sera of cervical cancer patients.

Sera obtained from 137 cervical cancer patients were analysed for the presence of antibodies to the human papillomavirus (HPV) type 16 proteins E6 and E7 by the aid of different assays, i.e. ELISA using as antigen either synthetic peptides or the complete E7 protein and radio-immunoprecipitation (RIPA) which uses the viral protein made by in vitro transcription/translation. In agreement with previous reports, reactivity to the E7 protein was found more frequently than to the E6 protein (31.4% vs. 16.8%) when the sera were assayed by peptide-based ELISA. In contrast, when RIPA was employed, reactivity to either protein was obtained at similar frequency (38.7% vs 46.7%). When the protein was denatured prior to immuno-precipitation the reactivity was lost in all sera tested for E6-specific antibodies but only in a few samples in the E7-RIPA. Therefore it was concluded that the increased sensitivity of the E6-RIPA as compared to the E6 peptide-ELISA is due to the detection of antibodies to conformational epitopes which are presented by the in vitro product but not by the synthetic peptides. Eighty-two sera from healthy donors were tested by HPV 16E6- and E7-RIPA and also by ELISA using the HPV 16E7 protein which was produced in the fission yeast Schizosaccharomyces pombe. One sample reacted each in the E6- and E7-RIPA indicating a high specificity of these assays. The E7 protein-ELISA proved to be less sensitive for the detection of antibodies in cervical cancer patients' sera (22.6% positive) as compared to peptide-based ELISA or RIPA.

Adolescent↗
PubMed2005

Delivering cervical cancer prevention services in low-resource settings.

The goals of any cervical cancer prevention program should be threefold: to achieve high coverage of the population at risk, to screen women with an accurate test as part of high-quality services, and to ensure that women with positive test results are properly managed. This article focuses on the experiences of the Alliance for Cervical Cancer Prevention (ACCP) in delivery of screening and treatment services as part of cervical cancer prevention projects in Africa, Latin America, and Asia. Research and experience show that cervical cancer can be prevented when strategies and services are well planned and well managed and when attention is paid to program monitoring and evaluation. Coordination of program components, reduction of the number of visits, improvement of service quality, and flexibility in how services are delivered are all essential features of an effective service.

Africa↗
PubMedDate not supplied

Importance of human papillomavirus endemicity in the incidence of cervical cancer: an extension of the hypothesis on sexual behavior.

The risk of cervical cancer for a woman depends largely on the probability of being infected with some specific types of Human Papillomavirus (HPV). In the control groups of four case-control studies in Colombia and Spain we have shown a strong correlation between the number of sexual partners of males and females and HPV DNA prevalence in the genital tract. Our results suggest that the lifetime number of sexual partners in both sexes are surrogates of the probability of HPV infection and, as such, insufficiently explain the geographical variation in the incidence of cervical cancer. It is proposed that the high rates of cervical cancer in Latin America are linked to the largely unknown characteristics of the HPV endemicity in the population and to the absence of widespread screening for cervical neoplasia. Reliable surveys on the HPV prevalences in selected social groups (i.e., young males and prostitutes) as well as in populations in countries at different risk of cervical cancer are required.

Adult↗
PubMed2006

Insulin-like growth factor 1 is a potent stimulator of cervical cancer cell invasiveness and proliferation that is modulated by alphavbeta3 integrin signaling.

Insulin-like growth factor 1 (IGF-1) has been implicated in promoting mitogenic, metastatic and antiapoptotic phenotypes in several types of cancer. But little is known about the signal interaction of IGF-1 and integrin in the regulation of cervical cancer development and progression. This study is to investigate the regulatory mechanism of IGF-1 receptor (IGF-1R) signaling and its importance in cervical cancer formation. The growth and invasiveness of cervical cancer cells (SiHa and CaSki) were dose-dependently stimulated by IGF-1, whereas those of normal cervical epithelial cells were not. The immunoblot showed that IGF-1R proteins were abundant in cervical cancer cell lines. In contrast, IGF-1R protein was nearly undetectable in normal cervical epithelial cells. IGF-1-stimulated invasion and proliferation were abolished by functional-blocking monoclonal antibody against IGF-1R, whereas these cellular functions were unaffected by either IgG or monoclonal antibody to insulin receptor. Functional-blocking monoclonal antibody against integrins alpha(v)beta3, but not alpha2 alpha3, alpha4 alpha6 beta1, beta4 or alpha2beta1, inhibited the IGF-1-stimulated invasion and proliferation in cervical cancer cells. alpha(v)beta3 integrin modulated IGF-1R phosphorylation by altering the rate of Src homology 2-containing phosphotyrosine phosphatase (SHP-2) recruitment to the activated IGF-1R. The modulation of alpha(v)beta3 occupancy also affected the activation of IGF-1R downstream-signaling elements, including activation of Akt and extracellular signal-regulated protein kinases 1/2 (Erk1/2). The treatment of blocking antibody of alpha(v)beta3 integrin or IGF-1R significantly inhibited tumor growth and caused tumor regression in SCID mice model. Immunoblots of tumor tissues confirmed that the phosphorylation of IGF-1R and downstream targets of Akt and Erk1/2 were remarkably decreased in SCID mice treated with blocking antibodies of alpha(v)beta3 or IGF-1R. Thus, these data suggest that the signal interaction between IGF-1R and alpha(v)beta3 integrin plays an important role in promoting the development and progression of cervical cancer.

Animals↗
PubMed2006

Assessing awareness and knowledge of breast and cervical cancer among Appalachian women.

INTRODUCTION: West Virginia is the only state that lies entirely within Appalachia. West Virginians tend to be poorer and more likely to lack health insurance than the general U.S. population. The purpose of this qualitative study was to 1) obtain an understanding of attitudes about breast and cervical cancer screening among women aged 25 to 64 years; 2) determine factors that motivate women to be screened for breast and cervical cancer; and 3) evaluate educational materials about breast and cervical cancer screening for use in this population. METHODS: The West Virginia Breast and Cervical Cancer Screening Program (WVBCCSP) is a comprehensive public health program, funded by the Centers for Disease Control and Prevention, dedicated to removing barriers to breast and cervical cancer screening and providing screenings to underserved women aged 25 to 64 years. The program partnered with RMS Strategies, Inc, to conduct six focus groups in three communities in West Virginia. Women were recruited by telephone based on program eligibility guidelines. RESULTS: Results indicated that women were concerned about health care costs and lack of health insurance. Cost, fear, and embarrassment were identified as the top barriers to breast and cervical cancer screening. Participants believed that community-based educational campaigns would increase screening and promote use of the WVBCCSP. CONCLUSION: Understanding why low-income Appalachian women do not get screened for breast and cervical cancer and determining motivational factors that encourage screening are important to increase screening rates among this population. Breast and cervical cancer efforts that use the words, knowledge, and suggestions of the women they serve are more likely to be effective and have a larger impact.

Adult↗
PubMed2003

Smoking and cervical cancer: pooled analysis of the IARC multi-centric case--control study.

BACKGROUND: Smoking has long been suspected to be a risk factor for cervical cancer. However, not all previous studies have properly controlled for the effect of human papillomavirus (HPV) infection, which has now been established as a virtually necessary cause of cervical cancer. To evaluate the role of smoking as a cofactor of progression from HPV infection to cancer, we performed a pooled analysis of 10 previously published case-control studies. This analysis is part of a series of analyses of cofactors of HPV in the aetiology of cervical cancer. METHODS: Data were pooled from eight case-control studies of invasive cervical carcinoma (ICC) and two of carcinoma in situ (CIS) from four continents. All studies used a similar protocol and questionnaires and included a PCR-based evaluation of HPV DNA in cytological smears or biopsy specimens. Only subjects positive for HPV DNA were included in the analysis. A total of 1463 squamous cell ICC cases were analyzed, along with 211 CIS cases, 124 adeno- or adeno-squamous ICC cases and 254 control women. Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression models controlling for sexual and non-sexual confounding factors. RESULTS: There was an excess risk for ever smoking among HPV positive women (OR 2.17 95%CI 1.46-3.22). When results were analyzed by histological type, an excess risk was observed among cases of squamous cell carcinoma for current smokers (OR 2.30, 95%CI 1.31-4.04) and ex-smokers (OR 1.80, 95%CI 0.95-3.44). No clear pattern of association with risk was detected for adenocarcinomas, although the number of cases with this histologic type was limited. CONCLUSIONS: Smoking increases the risk of cervical cancer among HPV positive women. The results of our study are consistent with the few previously conducted studies of smoking and cervical cancer that have adequately controlled for HPV infection. Recent increasing trends of smoking among young women could have a serious impact on cervical cancer incidence in the coming years.

Adenocarcinoma↗
PubMed2004

Defining the priority of using 18F-FDG PET for recurrent cervical cancer.

UNLABELLED: PET with 18F-FDG has shown its potential in cervical cancer. For maximizing the benefits of this new imaging technology, we aimed to define the prognostic features of recurrent cervical cancer patients for selecting appropriate candidates using 18F-FDG PET. METHODS: Patients enrolled were from 2 independent prospective studies investigating the role of 18F-FDG PET in cervical cancer patients after definitive treatment with documented failure (CTRP-018) or unexplained elevated tumor marker serum levels (CTRP-016) and proven relapse after PET. A total of 55 eligible patients received PET and CT or MRI. Lesion status was determined from pathologic results or clinical follow-up. The benefits calculated were based on treatment that was modified because of the PET findings. The Cox proportional hazards ratio (HR) was used to select independent prognostic covariates. RESULTS: Thirty-six (65.5%) patients had treatment that was modified due to PET. Primary radiation (HR = 14.62; 95% confidence interval [CI] = 2.74-77.92), squamous cell carcinoma antigen (SCC-Ag) > or = 4 ng/mL (HR = 5.82; 95% CI = 1.53-22.04), and presence of symptoms (HR = 6.24; 95% CI = 1.99-19.61) at recurrence were significant factors associated with poor survival. A scoring system using these covariates defined 3 distinct prognostic groups: score < or = 1 (HR = 1.00); score = 2 (HR = 6.91; 95% CI = 1.49-32.14); and score = 3 (HR = 60.46; 95% CI = 9.68-378.09) (P < 0.0001). CONCLUSION: Using this risk score, 18F-FDG PET may offer maximal benefits by selecting appropriate recurrent cervical cancer patients for salvage therapy with precise restaging information.

Adult↗
PubMedDate not supplied

A possible association between survival time and transfusion in cervical cancer.

Some studies suggest that transfusion may be associated with an increased risk of recurrence of and death due to malignant human neoplasms. We examined retrospective data from patients with cervical cancer to see if any association between transfusion of blood at the time of initial treatment and the time interval to recurrence and death could be detected in this cancer. In 130 patients with cervical cancer, seen over a ten-year period at our institution, there was a trend toward earlier recurrence in transfused patients, but this trend did not achieve statistical significance. Death due to cervical cancer recurrence occurred after a median of Death due to cervical cancer recurrence occurred after a median of 12 months in the transfused patients and a median of 68 months in the non-transfused individuals, which was statistically significant. Transfused patients had, on average, more favorable prognostic factors than those not transfused, such as less advanced clinical stage of disease. Analysis using a proportional hazards risk model failed to demonstrate a significant association between transfusion and time to recurrence when other prognostic factors were considered, but a significant association between transfusion and time to cancer-related death (p less than 0.05) was found. While these results cannot be viewed as conclusive due to the small number and heterogeneity of the patients analyzed, our data support the possibility of an association between transfusion and cervical cancer survival. Further studies are warranted to confirm or refute this relationship.

Blood Transfusion↗
PubMed1997

Physical status and expression of HPV genes in cervical cancers.

It is known that E2 protein of oncogenic human papillomavirus (HPV) inhibits the expression of E6 and E7 genes from their major promoters in vitro and suppresses the proliferation of cervical cancer cells. This suggests that the loss of functional E2 gene may provide selective advantages in the development of cervical cancer. Investigation of the relationship between the disruption of HPV-16/18 E2 genes by DNA integration and clinical outcome of cervical cancer may not only help to understand the mechanism of HPV-related cervical carcinogenesis, but may also provide novel management of cervical cancer. It was noted that integrated HPV-16/18 DNA was predominant in most patients with cervical cancers, marking 51 of a total of 68 cases (75%); episomal HPV DNAs were found in 5 cases (7.4%), and finally mixed forms of HPV DNAs with episome and integration were found in 12 cases (17.6%). Whole portions of E2 DNA of HPV-16 could be amplified by PCR in 19 (36.5%) of 52 cases of cervical intraepithelial neoplasia. It was shown that there was not statistically significant association with the different stages, but integrated HPV DNAs were detectable only in the patients with far-advanced stage of cervical cancers, which also means no episomal forms were detected. Episomal forms of HPV DNA were detectable in 14 (25.9%) of 54 squamous cell carcinomas (4 pure episomal forms and 10 mixed forms), whereas only 1 (8.3%) of 12 adenocarcinomas and adenosquamous cell carcinomas contained episomal viral DNA. When HPV DNA forms were compared with initial tumor size, lymphovascular space involvement, and frequency of nodal metastasis, statistically significant relationships were not found. The association of DNA integration with invasive cervical cancers was seen regardless of HPV type; however, there were differences between the integration profiles of HPV-16 and HPV-18 DNA. Of the 51 HPV-16-containing cancers, 36 (70.6%) revealed purely integrated HPV DNA, and another 10 cases (19.6%) displayed both integrated and episomal HPV DNAs. However, 5 (9.8%) cases showed only episomal copies of the HPV-16 genome. In contrast, all 17 HPV-18-containing cancers (5 cases positive for HPV-18 and 12 cases positive for both HPV-16 and -18) revealed only the integrated form of HPV-18 DNA. The expression of E6 and E7 transcripts of HPV-16/18 is uniformly correlated with the physical status of HPV DNAs. HPV E2 mRNAs were constantly expressed in the presence of the intact virus in cases with episome and mixed forms of HPV DNA. In general, amplified signals from HPV E2 RT-PCR are more intensive than those from DNA-PCR in the same patients. It is suggested that RT-PCR is a valuable method to evaluate dynamic expression of the specific gene and seems to be more sensitive than the DNA-PCR method in detecting intact E2 gene because of the gene copy numbers.

Base Sequence↗
PubMed2004

Cervical cancer screening beliefs among young Hispanic women.

OBJECTIVES: This study examined beliefs, attitudes, and personal characteristics that correlated with self-reported cervical cancer screening history among Hispanic women aged 18 to 25 years old in El Paso, TX, a large metropolitan area on the U.S.-Mexico border. METHODS: Data were collected through a cross-sectional, face-to-face survey. The study questionnaire was based primarily on the Health Belief Model, and included scales that measured perceived susceptibility and seriousness of cervical cancer, and perceived benefits and barriers to Pap test screening. The study questionnaire also included measures of acculturation, Pap test history, pregnancy and sexual history, use of birth control, type of medical insurance, and educational attainment. RESULTS: Sixty-nine percent reported ever having had a Pap test and 56% reported having had a test in the past year. Eighty percent reported that they were sexually active, and of these, 63% reported using birth control. Respondents understood the seriousness of cervical cancer, their susceptibility to cervical cancer, and the benefits of Pap testing; however, only 61% agreed that most young women whom they know have Pap tests. Greater acculturation and the belief that most young unmarried women have Pap tests were positively associated with ever having screening. The perception that the test would be painful and not knowing where to go for the test were negatively associated with ever having a Pap test. CONCLUSIONS: This study found suboptimal rates of screening for cervical cancer in a sample of young Hispanic women residing along the U.S.-Mexico border. Although women may understand the seriousness of cervical cancer and the benefits of screening, perceptions about Pap tests may pose barriers to undergoing screening. Efforts to increase screening also may need to focus specifically on women who are least acculturated, as they also were least likely to have had prior Pap tests.

Adult↗
PubMed1992

Prognostic importance of human papillomavirus type 16 DNA in cervical cancer.

Human papillomavirus (HPV) type 16 DNA is frequent in invasive cervical cancers. Among 43 patients with invasive cervical cancer, HPV-16-positive tumors spread to the parametrial and pelvic lymph nodes significantly more often than did HPV-16-negative tumors (P less than 0.05). Demonstration of HPV-16 DNA in invasive cervical cancers may be an additional prognostic factor for this disease.

Adult↗
PubMed1999

Serum soluble ICAM-1 levels in the patients with cervical cancer.

BACKGROUND: We hypothesize that serum levels of the soluble intercellular adhesion molecule-1 (s-ICAM-1) in patients with cervical cancer are significantly higher than that in healthy donors and this is examined in vivo, and in vitro. METHODS: We measured the serum levels of the s-ICAM-1 in patients with cervical cancer. Furthermore, in vitro, we examined the relationship between the expression of ICAM-1 on the cell surface of cultured cervical cancer cells and the s-ICAM-1 levels in the spent media. RESULTS: The mean+/-s.d. in the patients with cervical cancer 884.4+/-332.4 ng/ml were significantly (all, p<0.001) higher than those of normal controls (mean 364.6+/-134.8 ng/ml) and in patients with benign disease (536.3+/-204.8 ng/ml). Interferon-gamma (IFN-gamma) treated cells expressed more ICAM-1 on cell surfaces than did the non-treated cells, and s-ICAM-1 shed in the spent media from IFN-gamma treated cells were much higher than those of non-treated cells. CONCLUSIONS: These results indicate that the reason for increase of s-ICAM-1 in the patients with cervical cancer were both expression and shedding of ICAM-1 from cervical cancer cells especially influenced by cytokines, for example, IFN-gamma from surrounding lymphocytes.

Adult↗
PubMedDate not supplied

Cervical cancer screening in low resource settings using visual inspection with acetic acid.

Cervical cancer is one of the leading causes of death for middle-aged women in the developing world, yet it is almost completely preventable, if precancerous lesions are identified and treated in a timely manner. Cervical cancer screening based on cytologic examination is largely unavailable in developing countries or made available to a small, select group of women in private facilities, maternal child health sites, or family-planning clinics, missing the age groups at highest risk for precancerous lesions. Visual inspection with acetic acid (VIA) can be used to screen women. It can be done by nurses or midwives with appropriate training. Although still under investigation, research results show that VIA is simple, accurate, cost-effective, and acceptable to most women. This article reviews the natural history of cervical cancer and important aspects to consider related to cervical cancer screening in low resource settings. The VIA technique is described in detail.

Acetic Acid↗
PubMed2005

Increased expression of GRP94 protein is associated with decreased sensitivity to X-rays in cervical cancer cell lines.

PURPOSE: Radiation therapy is one of the standard treatments for cervical cancer. Glucose regulated protein 94 (GRP94) is a molecular chaperone, which increases in amount after X-ray irradiation. This study examined the involvement of GRP94 in radio-resistance in human cervical cancer cells. MATERIALS AND METHODS: Seven human cervical carcinoma cell lines (HeLa, SKG-I, SKG-IIIb, QG-U, Caski, SiHa and C33A) were examined for basal levels of GRP94 protein by western blotting analysis. Sensitivity to X-ray irradiation of these cell lines was determined with a colony survival assay. The suppression of GRP94 expression was performed using specific small-interfering RNA (siRNA) in HeLa and Caski cells. RESULTS: HeLa cells and QG-U cells, with higher basal levels of GRP94, exhibited a low sensitivity to X-ray cell killing. In HeLa cells, the sensitivity increased when protein GRP94 levels were reduced by specific siRNA transfection. However, a reduction in GRP94 protein had little effect on the X-ray sensitivity of Caski cells, which expressed low basal GRP94 protein levels but showed a low sensitivity to X-rays. CONCLUSIONS: High basal protein levels of GRP94 were correlated with a modest decrease in sensitivity to X-ray cell death in some cervical cancer cell lines. These results suggest that higher GRP94 protein expression is one of the molecular mechanisms causing resistance to radiation, and therefore GRP94 siRNA might be useful in tumor-specific gene therapy by reversing radio-resistance prior to radiation in cervical cancer.

Biomarkers, Tumor↗
PubMed2003

[Clinical evaluation of laparoscopic radical hysterectomy with pelvic and para-aortic lymphadenectomy in patients with cervical cancer].

OBJECTIVE: To evaluate the effective, results and complications in patients with cervical cancer who consented to undergo laparoscopic radical hysterectomy and retroperitoneal lymphadenectomy. METHODS: In 57 consecutive patients with stage Ia to IIb cervical cancer, laparoscopic radical hysterectomy and lymphadenectomy were performed. Forty-eight patients had squamous cell carcinomas, 7 patients had adenocarcinomas, and 2 patients had adenosquamous carcinomas of the cervix. RESULTS: All but 2 surgical procedures were completed laparoscopically. The average operative time was 186 min (150 - 320 min). The average blood loss was 168 ml (120 - 700 ml). Average numbers of pelvic and paraaortic lymph nodes removed were 18.6 (12 - 23) and 8.2 (6 - 12), respectively. Eight patients (14.0%) had positive lymph nodes. All surgical margins were macroscopically negative. Operative cystotomies occurred in 2 patients and one patient with venous injuries were repaired laparoscopically. Two other patients underwent laparotomy to control bleeding or repair ascending colon. After surgery, patients passed gas in 2.3 days and self-voided in 10.2 days on average. Follow-up has been provided every 3 months. There have been 3 cases of recurrences, one patient uncontrolled, and one patient ureteral constriction. Three patients have retention of urine. CONCLUSIONS: Laparoscopic radical hysterectomy and lymphadenectomy can be successfully completed in patients with cervical cancer with acceptable operation complications, a less injury and recovery time, and may become preferred for treating early cervical cancer.

Adult↗
PubMed2003

[Incidence of cervical cancer in women in North-Holland by country of birth from 1988-1998].

OBJECTIVE: To describe the incidence of cervical cancer in women in North-Holland by country of birth. DESIGN: Descriptive epidemiological study based on data from cancer registries. METHOD: The number of cases of cervical cancer in North-Holland for the period 1988-1998 was determined using data from the regional cancer registry of the Comprehensive Cancer Centre, Amsterdam. Based on data from the Netherlands Cancer Registry, a comparison was made between the observed (O) and the expected (E) number of cases by area of residence (i.e., Amsterdam versus the rest of North-Holland) and by the woman's country of birth. RESULTS: In the period 1988-1998, the incidence of cervical cancer among women living in North-Holland was significantly higher than that of the nation as a whole (O/E-ratio: 1.2; 95% CI: 1.1-1.2). In particular, the incidence of cervical cancer for women living in Amsterdam (O/E-ratio: 1.5; 95% CI: 1.4-1.6), and for women born in Morocco (O/E-ratio: 2.1; 95% CI: 1.4-3.1) or Surinam (O/E-ratio: 1.5; 95% CI: 1.1-2.0) was much higher. The country of birth was unknown in 10% of the women. The percentage of patients with extension of the disease outside the uterus (TNM-stages II-IV) did not differ between women born in the Netherlands and those born abroad. CONCLUSION: The incidence of cervical cancer during the period 1988-1998 was significantly higher for women living in Amsterdam and for women born in Morocco or Surinam than that for the Netherlands as a whole. No significant difference in stage of disease at diagnosis was observed between women born in the Netherlands versus those born abroad.

Adolescent↗
PubMed2006

Cervical cancer prevention in the era of prophylactic vaccines: a preview for gynecologic oncologists.

OBJECTIVE: The recent approval of a vaccine to prevent HPV infection is an important advance in cervical cancer prevention. This article is intended to provide gynecologic oncologists with a comprehensive background in modern cervical cancer prevention strategies. METHODS: We describe and contrast the quadrivalent and bivalent vaccines. More established cervical cancer prevention strategies are reviewed, with comments on the impact of HPV vaccination. Clinical guidance is provided for use of the approved quadrivalent vaccine. Safety and side effects of both vaccines are reviewed and future questions and challenges are explored. RESULTS: It is vitally important that both vaccinated and unvaccinated women continue to fully engage in cervical cancer prevention, including cervical cancer screening, follow-up of abnormal screens, and treatment of premalignant lesions. A quadrivalent virus-like particle vaccine has now been approved for use in girls and women ages 9 to 26. A bivalent vaccine may be available soon. Vaccine efficacy in clinical trials has been outstanding, with 100% protection against HPV-type-specific cervical intraepithelial neoplasia (CIN) II and III. CONCLUSIONS: Comprehensive cervical cancer protection now includes prophylactic vaccination for girls and young women in addition to screening and treatment of premalignant changes. Gynecologic oncologists will continue to play an important role in promoting optimal prevention practices.

Adolescent↗