HPV vaccine impact in Australian women: ready for an HPV-based screening program.

4v HPV1⁄4quadrivalent human papillomavirus. *Using Australian Institute of Health and Welfare indicator 4.2, which includes high-grade squamous abnormality, cervical intraepithelial neoplasia (CIN) grade 2, CIN grade 3 or CIN not otherwise specified; high-grade endocervical abnormality, endocervical dysplasia; and high-grade endocervical abnormality, adenocarcinoma in situ (http:/ www.aihw.gov.au/publication-detail/?id1⁄460129550871). u Ibased cervical screening program using primary human papillomavirus (HPV) DNA testing for all women, whether they have received HPV vaccination or not. Commencing HPV screening at 25 years of age is only possible in the context of a decrease in high-riskHPV prevalence in young women. This is because in an unvaccinated population of young women, infection with HPV (particularly the most oncogenic types,HPV16 and18) is common and would result in overreferral of women who test positive for HPV 16 or 18 to colposcopy for infections never destined to persist or cause disease. Since the implementation of the quadrivalent HPV vaccination program in Australia between 2007 and 2009, when over half of all women aged 12e26yearswere fullyvaccinated, the prevalence ofHPV16and18 inyoung women has declined dramatically.