HPV vaccination with twice-lifetime screening can eliminate cervical cancer in poorer countries

  • Brisson M & et al.
  • Lancet
  • 30 Jan 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • According to WHO projections, high HPV vaccination coverage (>90%) of girls with twice-lifetime screening in low-income and lower-middle-income countries (LMICs) over the next century would eliminate cervical cancer, drastically reduce incidence, and prevent >74 million cases.

Why this matters

  • HPV vaccination coverage and screening uptake are low in LMICs, despite evidence demonstrating their efficacy and cost-effectiveness.

Study design

  • Models predicted the effect of HPV vaccination of girls aged 9 years with catch-up to age 14 years±cervical screening on cancer incidences in 78 LMICs from 2020 to 2120 vs status quo.
  • Funding: WHO. 

Key results

  • HPV vaccination+twice-lifetime screening would:
    • Reduce incidence by 96.7% (from 19.8 to 0.7 cases per 100,000 women-years).
    • Eliminate cervical cancer in 100% of LMICs.
    • Avert 74.1 million cases.
  • HPV vaccination alone would:
    • Reduce the cervical cancer incidence by 89.4% (decline to 2.1 cases per 100,000 women-years).
    • Eliminate cervical cancer in 60% (range, 58%-65%) of LMICs.
    • Avert 61.0 million cervical cancer cases.
  • Vaccination+once-lifetime screening would:
    • Reduce incidence by 95% (decline to 1.0 [0.9-2.0] cases per 100,000 women-years).
    • Eliminate cervical cancer in 96% of LMICs.
    • Avert 67.8 million cases.

Limitations

  • Demographic/behavioral changes and technical development over the next century were not accounted for.