Introduction:
Cervical cancer and its precursor lesions are caused by a persistent
infection with oncogenic types of human papillomavirus (hr-HPV)(1, 2).
Worldwide, cervical cancer is diagnosed annually in more than 500,000
women(3, 4). Many studies have proven the efficacy and safety of a
prophylactic HPV vaccine against the development of cervical
intraepithelial neoplasia (CIN)(5). Therefore, cervical cancer (and
other HPV-related diseases) are readily preventable with vaccinations.
About 80% of the HPV infections are cleared spontaneously by the
body(6). It is not clear why this has not happened in women with a
persistent HPV infection. These women are at risk for the development of
CIN. Other premalignant conditions caused by a persistent HPV infection
are vaginal, vulvar and anal dysplasia(7) and can also lead to cancer.
Different methods are available for the treatment of CIN. The most
commonly used method is the Loop Electrosurgical Excision Procedure
(LEEP). This procedure enables treatment and provides a reliable
histologic interpretation(8). Nevertheless, treatment has been
associated with side effects such as hemorrhage, infection, as well as
with adverse pregnancy outcomes, such as premature rupture of membranes
and premature birth. The risk of adverse pregnancy outcomes occur
especially after multiple treatments(9-11).
Data on recurrent disease after treatment vary in the literature. Up to
17% of the women treated for cervical dysplasia can have residual or
recurrent dysplasia(12) with repeated treatment as result. Especially
adverse pregnancy outcomes are reasons for concern. Most women diagnosed
with CIN are at reproductive age (25-40 years). Moreover, women treated
for CIN have an increased risk of cervical vagina and vulvar cancer
compared to women with normal primary smear test results(13, 14).
Furthermore the cost efficiency of HPV vaccines is highly underestimated
because adverse obstetrical outcomes, especially prematurity with
neonatal morbidity and mortality, are not taken into account(15).
To avoid recurrent disease, the HPV infection should be prevented first.
Different prophylactic HPV vaccines have been massively tested in big
clinical trials. The vaccines are highly effectives against mainly HPV
types 16 and 18. These clinical trials reported no clear therapeutic
effect on patients with prior HPV exposure. Nonetheless, there is
increasing evidence of an additional vaccine effect after treatment of
clinical HPV related anogenital, dermal and oropharyngeal
diseases(16-19). We performed a review of the literature with the aim of
determining whether vaccination with an HPV vaccine in addition to LEEP
treatment is effective in decreasing the recurrence of CIN.