WHO's cervical cancer reduction goals are achievable for lower-to-middle-income countries

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

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • WHO’s goal of cervical cancer reduction by the century’s end is possible but requires ≥90% HPV vaccination coverage in girls residing in low-income, low-middle-income countries (LMICs).

Why this matters

  • A concerted effort is needed to intensively scale-up offer/improve HPV vaccine uptake in all adolescent and young adult female patients.
  • Clinicians are urged to conduct HPV screening and to follow up in patients testing positive. 

Key results

  • Achieving 90% girls-only HPV coverage yields:
    • 89.4% (range, 86.2%-90.2%) reduction in median age-standardized LMIC cervical cancer incidence. 
    • 61.0 million (range, 60.5-63.0 million) cases averted overall.
  • HPV vaccine plus once-lifetime screening:
    • 95.0% (range, 89.0%-95.3%) reduction in median age-standardized LMIC cervical cancer incidence.
    • Another +6.8 million (range, 4.3-9.4 million) cases averted.
  • HPV vaccine plus twice-lifetime screening:
    • 96.7% (range, 91.3%-96.7%) reduced average age-standardized LMIC cervical cancer incidence;
    • A total of 74.1 million (range, 70.4-75.1 million) cases averted.
  • Vaccinating boys in addition to girls is insufficient to improve cancer rates in countries with highest age-standardized cervical cancer incidence (e.g., Uganda).
  • Multiage cohort vaccination (to age 25 years) is ineffective against cervical cancer incidence at equilibrium.

Study design

  • Comparative modeling analysis to identify HPV-prevention strategies, timing, and number of averted cervical cancer cases for different thresholds, country characteristics.
  • Funding: WHO.

Limitations

  • Future confounders likely.
  • Intensive scale-up assumed.
  • HPV/HIV interactions unaccounted for. 
  • Underestimated cases.