Public Health Advances in Cervical Cancer Prevention
More than 30 years of epidemiologic research by DCEG investigators has helped to establish the central causal role of carcinogenic genotypes of human papillomavirus (HPV) in the development of virtually all cases of cervical cancer. NCI’s natural history studies have shown that persistent HPV infection increases the risk of developing cervical cancer. This finding led to the creation and adoption of screening and clinical management guidelines by numerous organizations: the American Cancer Society, ASCCP, the Association of Clinical Obstetricians and Gynecologists, and the World Health Organization (WHO).
Primary Prevention through HPV Vaccination
NCI scientists invented the virus-like particle technology that enabled the development of HPV vaccines to prevent infection and resultant cancer. An NCI-sponsored Phase III clinical trial to evaluate the efficacy of a vaccine against HPV types 16 and 18 showed near-complete protection against new infections and precancerous lesions. Strategies to prevent cervical cancer have shifted from reliance on untargeted, frequent, and lifelong repetition of Pap smears to a combination of vaccination and targeted HPV-based screening.
Secondary Prevention through Screening and Clinical Management
DCEG investigators had important roles in the development and validation of HPV DNA tests that directly assay the causal virus over the last decades. These tests are now in widespread use in the U.S.; they provide greater accuracy than ambiguous Pap tests and have led to improved clinical management strategies, with lengthened screening intervals.
Between 2020 and 2021, several new guidelines were published for screening and clinical management of cervical precancer, including the American Cancer Society Cervical Screening Guidelines, the 2019 ASCCP Risk-Based Management Consensus Guidelines, and the WHO Cervical Screening Guidelines, based on research and input from DCEG investigators.
The Risk-Based Management Consensus Guidelines were published in a series of eight papers in the Journal of Lower Genital Tract Diseases, available free on the web and as a downloadable application for smartphones.
These guidelines utilize a risk-based approach and focus on HPV testing for primary screening. HPV testing, combined with other tests, like Pap cytology, can identify those patients with high-risk infections for closer follow-up, patients with precancer who require treatment to remove the precancer, or patients with cancer who need treatment. Paired with vaccination against HPV, they support the global effort to accelerate cervical cancer control.