Cervical screening has resulted in a major reduction in the incidence and 
mortality of cervical cancer in the UK and other developed countries. 
Nevertheless approximately 2700 women present with cervical cancer in the UK 
each year with mortality in excess of 1000 cases. Prophylactic HPV vaccination 
against HPV 16 and 18 has been shown to be highly effective in preventing HPV 
related malignancy in clinical trials. Newly introduced HPV vaccination 
programmes in the UK and elsewhere are ultimately likely to result in a further 
significant reduction in the incidence and mortality of cervical cancer. These 
vaccination programmes will be most effective in early adolescence when 
prevalence of HPV infection is low. Consequently, vaccination programmes in the 
UK have been initially targeted at 12 to 13-year olds. In Australia favourable 
estimates of cost effectiveness have supported funding of a 'catch-up' programme 
to 26 years. In the UK the catch up programme has for the present been 
restricted to 18 years for cost effectiveness reasons. In addition the value of 
HPV vaccination beyond 26 years has not yet been fully clarified. Nevertheless 
women up to 45 years of age have been shown to exhibit strong immune responses 
to the bivalent HPV vaccine which might be expected to reduce the risk of HPV 
re-infection and address the second peak of HPV related malignancy in later 
life, evident over 45 years of age. Early data from randomised trials testing 
the quadrivalent HPV vaccine in women over 25 years has suggested high vaccine 
efficacy comparable to younger women. This paper will explore the evidence 
supporting HPV vaccination in HPV naïve and HPV exposed sexually active women up 
to 26 years and beyond this age group.