HPV vaccination and HPV primary screening will change the landscape of HPV-associated disease. Cervical cancer accounts for the vast majority of HPV-associated cancers. It is now increasingly recognised that HPV is also implicated in other anogenital cancers including vulvar, vaginal, anal and penile. HPV vaccination will reduce the burden of HPV-associated diseases. However, HPV vaccination is not a panacea, and consideration of the implications of HPV vaccination is required.
HPV primary cervical screening will be implemented in late 2018. However, choosing an appropriate triage strategy for HPV positive women remains a key challenage. HPV-PATH will build on existing work from the CERVIVA HPV Primary Screening Study, which describes a panel of molecular markers for triaging HPV positive women. This study will embed within CervicalCheck, and apply the data on triage tests to the entire screening population [vaccinated/unvaccinated], generating data for defining optimal triage approaches for HPV positive women.
HPV vaccination will reduce the burden of other anogenital cancers. However, there is currently no data relating to HPV prevalence in anogenital cancers in Ireland. This creates difficulties in identifying the impact of HPV vaccination on non-cervical cancers. A population-based study on the epidemiology of HPV infection in other anogenital cancers, will be carried out, starting with vulvar cancer. This will build evidence around HPV vaccination and the potential impact on vulvar cancer.
Furthermore, anogenital cancers require further molecular characterisation. In parallel with HPV, p53 mutation appears to assume an important role in anogenital cancers. p53 and HPV molecular characterisation is required to further define distinct disease groups in anogenital cancers. HPV-PATH will characterise vulvar cancers based on HPV and p53 status and identify if distinct clinicopathological groups exist.
Ultimately, this research will generate actionable knowledge that can be translated to practice and policy for improved delivery in healthcare of HPV-associated diseases.
