Key Points
➤ Vaccination is the optimal strategy for primary prevention of infection by
some types of human papillomavirus that cause cervical cancer in the
target population. There is no other preventive strategy for this cancer that
can substitute for vaccination.
➤ There are three prophylactic HPV vaccines approved and recommended in
the United States, Europe, and many regions and countries: the bivalent
(2vHPV; against HPV 16 and 18), quadrivalent (4vHPV; against HPV 6, 11,
16, and 18), and nine valent (9vHPV; against HPV 6, 11, 16, 18, 31, 33, 45,
52 and 58)
• NOTE: Gardasil-9 (9-valent HPV vaccine) will be the only HPV vaccine available in
the United States after May 2017.
Source: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv.html.
➤ As a partial result of failures within different health care systems at both
levels of prevention—vaccination, screening—and disease treatment/
management, there are large regional and global disparities in cervical
cancer incidence and mortality. Consequently ASCO has established a
process for resource-stratified guidelines.
Framework of Resource Stratification: Primary Prevention
Setting
• Basic
Core resources or fundamental services that are absolutely necessary for any public
health/primary health care system to function: Basic-level services typically are applied in
a single clinical interaction. Vaccination is feasible for highest need populations.
• Limited
Second-tier resources or services that are intended to produce major improvements in
outcome such as incidence and cost-effectiveness and are attainable with limited financial
means and modest infrastructure. Limited-level services may involve single or multiple
interactions. Universal public health interventions feasible for greater percentage of
population than primary target group.
• Enhanced
ird-tier resources or services that are optional but important. Enhanced-level resources
should produce further improvements in outcome and increase the number and quality
of options and individual choice. (Perhaps ability to track patients and links to registries).
• Maximal
May use high-resource settings' guidelines.
High-level/state-of-the art resources or services that may be used/available in some
high-resource countries and/or may be recommended by high-resource setting guidelines
that do not adapt to resource constraints but that nonetheless should be considered a
lower priority than those resources or services listed in the other categories on the basis of
extreme cost and/or impracticality for broad use in a resource-limited environment.
To be useful, maximal-level resources typically depend on the existence and functionality of all lower level resources.
Prevention
