Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries

Abstract

Background The WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. To help inform global efforts, we modelled potential human papillomavirus (HPV) vaccination and cervical screening scenarios in low-income and lower-middle-income countries (LMICs) to examine the feasibility and timing of elimination at different thresholds, and to estimate the number of cervical cancer cases averted on the path to elimination. Methods The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC), which consists of three independent transmission-dynamic models identified by WHO according to predefined criteria, projected reductions in cervical cancer incidence over time in 78 LMICs for three standardised base-case scenarios: girls-only vaccination; girls-only vaccination and once-lifetime screening; and girls-only vaccination and twice-lifetime screening. Girls were vaccinated at age 9 years (with a catch-up to age 14 years), assuming 90% coverage and 100% lifetime protection against HPV types 16, 18, 31, 33, 45, 52, and 58. Cervical screening involved HPV testing once or twice per lifetime at ages 35 years and 45 years, with uptake increasing from 45% (2023) to 90% (2045 onwards). The elimination thresholds examined were an average age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years and ten or fewer cases per 100 000 women-years, and an 85% or greater reduction in incidence. Sensitivity analyses were done, varying vaccination and screening strategies and assumptions. We summarised results using the median (range) of model predictions. Findings Girls-only HPV vaccination was predicted to reduce the median age-standardised cervical cancer incidence in LMICs from 19•8 (range 19•4-19•8) to 2•1 (2•0-2•6) cases per 100 000 women-years over the next century (89•4% [86•2-90•1] reduction), and to avert 61•0 million (60•5-63•0) cases during this period. Adding twice-lifetime screening reduced the incidence to 0•7 (0•6-1•6) cases per 100 000 women-years (96•7% [91•3-96•7] reduction) and averted an extra 12•1 million (9•5-13•7) cases. Girls-only vaccination was predicted to result in elimination in 60% (58-65) of LMICs based on the threshold of four or fewer cases per 100 000 women-years, in 99% (89-100) of LMICs based on the threshold of ten or fewer cases per 100 000 women-years, and in 87% (37-99) of LMICs based on the 85% or greater reduction threshold. When adding twice-lifetime screening, 100% (71-100) of LMICs reached elimination for all three thresholds. In regions in which all countries can achieve cervical cancer elimination with girls-only vaccination, elimination could occur between 2059 and 2102, depending on the threshold and region. Introducing twice-lifetime screening accelerated elimination by 11-31 years. Long-term vaccine protection was required for elimination. Interpretation Predictions were consistent across our three models and suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in mos...

Cervical cancer vaccination awareness and acceptance among the females of Punjab, Pakistan

“…15 They can provide a high degree of protection against HPV type 16/18 infections and associated cervical lesions. 16,17 According to the recommendation of World Health Organization (WHO), the HPV vaccine should be given to girls aged 9-14, as the vaccine is highly effective prior to sexual debut. 18 South Asia bears almost one fourth of the burden of cervical cancers.…”

Human papillomavirus vaccine to prevent cervical cancer globally

“…Adding twice‐lifetime screening would reduce the incidence further to 0.7 cases per 100 000 woman‐years, preventing an additional 12.1 million cases. All three models gave consistent predictions . If high uptake of HPV vaccine can be achieved, cervical cancer could be eliminated globally by the end of the century.…”

“…In 2018, half of all new cervical cancers (290 000 of 570 000 worldwide) were in women living in LMICs. A World Health Organization study group used three different models to predict the effect of introducing HPV vaccination of girls at age 9 years, and cervical cancer screening at 35 and/or 45 years old in LMICs . It was estimated that HPV vaccination alone would reduce cervical cancer by 89% by 2100, from 19.8 to 2.1 cases per 100 000 woman‐years, thus preventing 61 million cases of cervical cancer.…”

Comment on “Will HPV vaccination prevent cervical cancer”

“…Up-to-date estimates of the impact and costeffectiveness of HPV vaccination and screening at national levels are required. Practicable and cost-effective strategies consist of HPV vaccination, and screening would accelerate the progress of cervical cancer elimination globally [9].…”