Screening for Cervical Cancer and Human Papillomavirus Vaccination in Israel: Recommendations

1. IntroductionThe Israel report, as part of the international review project onhuman papillomavirus (HPV) and cancer prevention, summarizes(i)thecurrentstatusoftheburdenofHPV-relateddiseasesinIsrael(BornsteinJetal.,Vaccine,thisissue[1]andShavitOetal.,Vaccine,this issue [2]), (ii) the current status of screening and HPV vac-cination, and the problems for the establishment of an organizedscreening program and a school-based HPV vaccination program(Schejter E et al., Vaccine, this issue [3]), (iii) the barriers to HPVvaccine acceptability (Fisher WA et al., Vaccine, this issue [4]) and(iv)thecost-utilityofdifferentpreventionstrategies(GinsbergGM,Vaccine, this issue [5]). This last chapter concentrates on the mainconclusions and therefore, provides the basis for settling recom-mendationsforthepreventionofHPVinfectionandcervicalcancerin Israel through primary and secondary prevention.Israel had a population of approximately 7,981,000 inhabitantsasof2012.Seventy-sixpercentofthemareJewsand21%non-Jews,mostly Arabs. Incidence rates of cervical cancer in Israel, as wellas incidence rates of other HPV-related malignancies in men andwomen are relatively low compared to most Western countries.However, mortality rates from cervical cancer and rates of cervicalintraepithelial neoplasia (CIN) and condyloma acuminata are simi-lartothoseincountrieswithhighercervicalcancerincidencerates(Fig. 1).Because of this low burden of cervical cancer, health policymakers in Israel decided to base cervical cancer prevention on