HPV: a virus in decline thanks to screening and vaccination

The first discovery of cervical cancer is attributed to Sir John Williams in 1886, when he described a lesion that corresponded to a carcinoma in situ of the cervix. Later history suggests that cervical cancer diagnosis relied upon examination of tissue biopsies from a visual lesion of the cervix. In the 1940s George Papanicolaou developed the ‘Pap test’ where normal and abnormal vaginal smears could be accurately classified by simple microscopic observational analysis.¹ This enabled the first cervical cancer cytology screening programmes to be developed. The advent of these screening programmes in Canada and the United States reduced the incidence and mortality due to cervical cancer significantly. Between 1969 and 1990 the incidence more than halved from 21.6 per 100,000 to 10.4 per 100,000, and mortality reduced from 7.4 per 100,000 to 2.4 per 100,000.¹

               In the early 1980s human papillomavirus (HPV) was found to be associated with cervical cancer. It was found in 99% of cervical cancer cases and is now recognised as the main cause of cervical cancer.² The discovery of the association between HPV infection and cervical cancer enabled the development of a vaccine for HPV. We live in a time when some people are sceptical of the benefits of disease screening and vaccination. Using the evidence base, we look back on the impact that these screening and vaccination programmes have had on the epidemiology, mortality and morbidity of HPV.

Human papillomavirus