Public health round-up

A guide for health-care providers in health centres and district hospitals to use in preventing and controling cervical cancer includes new recommendations on human papillomavirus (HPV) vaccination and testing. The Comprehensive cervical cancer control: a guide to essential practice, first published in 2006, has been revised to include scientific evidence published up to December 2013 and was released last month. The guide includes a new chapter on vaccination against HPV, which can cause cervical cancer. It proposes that girls aged 9 to 13 years should receive two doses of the vaccine, rather than three doses as previously recommended – a change that will save costs for health systems. The guide also includes a new recommendation to incorporate HPV testing in cervical cancer prevention programmes, a change that has the potential to increase the coverage of screening and improve the quality of national cervical cancer programmes. It advises that HPV testing should be offered to women aged over 30 years. However, if HIV prevalence is high, testing should be offered to younger women. If the test result is negative, the woman should not be tested again for at least five years. A positive test result – indicating that she may have a lesion or be at risk of developing cancer in the future – would need further investigation. HPV testing is being incorporated into cervical cancer prevention programmes in high-resource settings as a primary screening test, but samples need transportation and processing at a laboratory before results can be returned. A new low-cost test for HPV infection that can be processed with minimal laboratory infrastructure is being tried out in low-resource settings and may soon be available. The updated guide highlights the importance of communicating differently around cervical cancer prevention, now that HPV vaccines have been introduced. Instead of focusing on screening for women aged 30 and over, the guide recommends communicating with a wider audience, including adolescents, parents, educators and health professionals, to reach women throughout their lives. In 2012, an estimated 528 000 new cases of cervical cancer were diagnosed, and 266 000 women died of the disease, nearly 90% of them in lowto middleincome countries. Without urgent attention, deaths due to cervical cancer are projected to rise by almost 25% over the next 10 years. http://www.who.int/reproductiveehealth/publications/cancers/cervicalcancer-guide