In the United Kingdom, almost 3,400 women are diagnosed with cervical cancer each year, representing nearly 2% of all women diagnosed with cancer. Cervical cancer is, however, the most common cancer in women under 35 years old.

The major cause of the main types of cervical cancer – squamous cell cancer and adenocarcinoma – is HPV infection. [5] While there are over 200 types of human papilloma virus (HPV)[8], at least 40 types are passed on through sexual contact and cause a number of health related conditions, including cancer, in both men and women. [4] However, a great number of these viruses are known to cause warts and do not cause cell changes that develop into cancer.

Only a limited number of 15 types of HPV viruses, about 15 types are considered high risk for cancer of the cervix. This includes – types 16 and 18 which cause about 7 out of 10 cancers of the cervix. Women with persistent infections with these high risk types of HPV are more at risk of developing cervical cancer.

HPV is very common
It is estimated that 70-80% of sexually active women will be exposed to the HPV virus at some point in their life [3]. In most of these cases the virus does not cause harm. In nearly 90% of infected women the infection will clear on its own. However, it is not possible to predict which infections will be cleared and which will progress to disease and ultimately cancer.[7]

Prevention
Following a recommendation by the Joint Committee on Vaccination and Immunization (JCVI) in 2007, routine HPV immunisation of girls aged 12-13 years started in the United Kingdom in September 2008 with an initial accelerated catch-up vaccination of girls aged 13-18 years with the aim of preventing cervical cancer.

Today, the United Kingdom the Department of Health’s school girl vaccination program against the cervical cancer-causing HPV is one of the most successful in the world.[1] However, in one area, London, a steep decline in the acceptance has been noted. The UK’s capital has seen the lowest uptake rates in the country and the lowest rates of completion of the three-dose course[2].

London below average
A recently published Healthcare Protection Agency report showed an average uptake rate for three HPV doses in schoolgirls aged 12-13 years across London of 76% [2], compared with the national (England) average of 84% [1]. The report showed that while many London boroughs achieve high uptake rates, those in Barnet, Kingston, City & Hackney, Camden, and Kensington & Chelsea fell 20-30% below the national average for uptake of all three HPV vaccine doses among 12 to 13 year old girls in the 2010/2011 school year[2].

Commenting on the decline, Robert Music, Director of London based charity, Jo’s Cervical Cancer Trust, noted: “With research showing that an 80% uptake of the HPV vaccine year on year could see a two thirds reduction in cervical cancer incidence in women under 30 by 2025[6], it will make a real difference if girls continue to have all three doses of the vaccine. We would therefore like to encourage parents of both the girls who are eligible for the schools programme to ensure their daughters get the vaccine to help protect themselves against cervical cancer, but also remind the parents of those who are no longer in year eight but aged 17 and below that they can still have the vaccine on the NHS for free.”

To improve uptake rates in London, a campaign – 123 Against HPV – has launched. The, campaign, supported the vaccine developer Sanofi Pasteur MSD, involves advertising on the underground and bus routes across London, as well as on selected regional radio and newspaper outlets. The new campaign aims to raise awareness among parents of girls eligible for the vaccine about the availability, and the need to receive all three doses to be protected against disease caused by HPV infection.

References
[1] Health Protection Agency. Health Protection Report 2012;6(12):3-5. Last accessed on 4 December 2012
[2] Department of Health. Annual HPV vaccine coverage in England in 2010/11 report, 22 March 2012. Last accesses 4 December 2012
[3] Syrj?nen K et al. Prevalence, incidence and estimated life-time risk of cervical human papillomavirus infections in a nonselected finnish female population. Sex Transm Dis 1990;17[1]:15-19.
[4] Arbyn M et al. EUROGIN 2011 roadmap on prevention and treatment of HPV-related disease. Int J Cancer 2012; 131(9):1969-82.
[5] Cancer Research UK – Cervical cancer mortality statistics. Last accessed 4 December 2012
[6] J Cuzick et al. Predicted impact of vaccination against human papillomavirus 16/18 on cancer incidence and cervical abnormalities in women aged 20-29 in the UK. Br J Cancer 102, 933-939 doi:10.1038/sj.bjc.6605528
[7] Pagliusi SR, Aguado MT. Efficacy and other milestones for Human Papillomavirus vaccine introduction. Vaccine 2004;23:569-578.
[8] DeVilliers EM et al. Classification of papillomaviruses. Virology 2004;324:17-27.

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