HPV vaccination against cervical cancer in women above 25 years of age: key considerations and current perspectives.

OBJECTIVE Vaccination of young women (15-25 years of age) against human papillomavirus (HPV) has been shown to be very efficacious in preventing the development of moderate or severe cervical precancerous lesions associated with HPV-16 or -18. As the highest rates of new infections with high-risk (i.e., oncogenic) HPV types occur in the first years following sexual debut, most existing guidelines and recommendations advise on vaccinating young girls. We consider oncogenic HPV infection and the risk of developing cervical cancer in women over 25 years of age and whether they would also benefit from vaccination against HPV. METHODS We reviewed all available literature on oncogenic HPV infection and the risk of developing cervical cancer in women over 25 years of age. RESULTS HPV vaccination is likely to be beneficial to sexually active women due to their continuous risk of acquiring new HPV infections and of developing cervical intraepithelial neoplasia (CIN) and cervical cancer. Clinical trial data show that the HPV-16/18 AS04-adjuvanted vaccine is safe and immunogenic in women up to the age of 55 years, whilst preliminary data with the quadrivalent vaccine demonstrated evidence of safety, immunogenicity and high-level efficacy in women 24 to 45 years of age. HPV vaccination in women over 25 years of age is already approved in several countries, and these women are individually seeking advice on vaccination from healthcare professionals. The predicted reduction in cost benefit of vaccination with increasing age, however, is likely to limit the implementation of routine vaccination beyond the late 20s. CONCLUSION The priority of routine vaccination programmes must be to target girls and young women, with catch-up programmes that extend to age 25/26 when resources allow. For sexually active women over the age of 25, HPV vaccination can be considered on an individual basis, as most will have the potential to benefit from vaccination.