Early Detection of Cervical Carcinomas – Finding an Overall Approach: Vaccination is No Substitute for Early Detection?

by PD Dr. med. Nicolas Wentzensen, PD Dr. rer. nat. Stefanie J. Klug in volume 37/2008

Wentzensen and Klug write that the recently introduced vaccination against HPV is no substitute for cervical screening. They name three reasons-among others, that long term results regarding the protection conferred by the vaccine are lacking. Although they later concede that after vaccination, the uptake of cervical screening will fall, they demand that "vaccinated women should continue to undergo routine cervical screening."

I wish to vehemently oppose this conclusion.

– The information leaflet on cervical screening that was recently published on the homepage of the joint federal committee emphasized that women can decide freely whether they participate in screening or not. Participation is therefore absolutely not obligatory (1).
– If the three objections that the authors expressed towards replacing cervical screening could be eliminated then logically the conclusion that vaccination is no replacement for cervical screening would become invalid.

The correct conclusion would read: "For this reason, even vaccinated women should be offered cervical screening until such time as effective protection from vaccination is confirmed."

If it could be proved that vaccination reduces mortality due to cervical cancer by 70% this would mean that vaccination—especially compared with the benefits conferred by other early detection measures—offers effective protection that makes cervical screening a questionable measure, even according to the current international standards (2). DOI: 10.3238/arztebl.2009.0134a


Dr. rer. nat. Christian Weymayr
Schaeferstr. 22
44623 Herne, Germany
[e-mail]

Conflict of interest statement
Dr Weymayr served as an expert in the joint federal committee for the leaflet on early detection of cervical cancer.

References

1. Beschluss des Gemeinsamen Bundesausschusses über eine Änderung der Krebsfrüherkennungs-Richtlinien: Merkblatt Zervixkarzinomfrüherkennung, 21.8. 2008; http://www.g-ba.de/downloads/40-268-367/2007-06-05-Abschluss-Zervix.pdf

2. Raffle AE: Challenges of implementing human papillomavirus (HPV) vaccination policy. BMJ 2007; 335: 375–7.

3. Wentzensen N, Klug SJ: Early detection of cervical carcinomas [Früherkennung des Zervixkarzinoms – Suche nach einem Gesamtkonzept]. Dtsch Arztebl Int 2008; 105(37): 617–22.