The projected timeframe until cervical cancer elimination in Australia: a modelling study

Abstract

Background In 2007, Australia was one of the first countries to introduce a national human papillomavirus (HPV) vaccination programme, and it has since achieved high vaccination coverage across both sexes. In December, 2017, organised cervical screening in Australia transitioned from cytology-based screening every 2 years for women aged from 18-20 years to 69 years, to primary HPV testing every 5 years for women aged 25-69 years and exit testing for women aged 70-74 years. We aimed to identify the earliest years in which the annual age-standardised incidence of cervical cancer in Australia (which is currently seven cases per 100 000 women) could decrease below two annual thresholds that could be considered to be potential elimination thresholds: a rare cancer threshold (six new cases per 100 000 women) or a lower threshold (four new cases per 100 000 women), since Australia is likely to be one of the first countries to reach these benchmarks. MethodsIn this modelling study, we used Policy1-Cervix-an extensively validated dynamic model of HPV vaccination, natural history, and cervical screening-to estimate the age-standardised incidence of cervical cancer in Australia from 2015 to 2100. We incorporated age-specific coverage of the Australian National HPV Vaccination Program in girls, including the catch-up programme, and the inclusion of boys into the vaccine programme from 2013, and a change from the quadrivalent to the nonavalent vaccine from 2018. We also modelled the effects of the transition to primary HPV screening. We considered two scenarios for future screening recommendations regarding the cohorts who will be and who have been offered the nonavalent vaccine: either that HPV screening every 5 years continues, or that no screening would be offered to these women. FindingsWe estimate that, in Australia, the age-standardised annual incidence of cervical cancer will decrease to fewer than six new cases per 100 000 women by 2020 (range 2018-22), and to fewer than four new cases per 100 000 women by 2028 (2021-35). The precise year of attaining these rates is dependent on the population used for age-standardisation, HPV screening behaviour and test characteristics, the incremental effects of vaccination of men on herd immunity in women, and assumptions about the future frequency of benign hysterectomies. By 2066 (2054-77), the annual incidence of cervical cancer will decrease and remain at fewer than one case per 100 000 women if screening for HPV every 5 years continues for cohorts who have been offered the nonavalent vaccine, or fewer than three cases per 100 000 women if these cohorts are not screened. Cervical cancer mortality is estimated to decrease to less than an age-standardised annual rate of one death per 100 000 women by 2034 (2025-47), even if future screening is only offered to older cohorts that were not offered the nonavalent vaccine.Interpretation If high-coverage vaccination and screening is maintained, at an elimination threshold of four new cases per 100 000 women annually, cervical cancer c...

Increasing risk of uterine cervical cancer among young Japanese women: Comparison of incidence trends in Japan, South Korea and Japanese‐Americans between 1985 and 2012

“…For most cancers in most high‐income countries, we have fortunately observed a trajectory of progress over the last several decades, as science uncovers ways to efficiently prevent cervical cancer by well‐organized cancer screening and high‐coverage HPV vaccination . As an exception to this, the increasing risk of cervical cancer among young women is an urgent concern.…”

Vaccine Safety: Myths and Misinformation

“…The misinformation surrounding HPV vaccines has tragically resulted in lower uptake in many countries, denying millions of adolescents the opportunity to be protected from fatal HPV-related cancers in later life. Meanwhile in Australia, where high uptake has been maintained, a recent modeling study indicates progress toward eliminating cervical cancer as a public health problem (Hall et al, 2019). Since entering the market in 2006 more than 270 million doses of the HPV vaccine have been administered worldwide, including 100 million in the United States (Centers for Disease Control and Prevention [CDC], 2019).…”

Improving Australian National Bowel Cancer Screening Program outcomes through increased participation and cost-effective investment

“…[49] Alongside screening, primary prevention is also a critical target area for intervention, as almost half of CRC cases in Australia are attributable to known modifiable risk factors. [50,51] To move towards the possibility of 'CRC elimination', as is now being proposed for cervical cancer (considering a potential elimination threshold of 4 cases per 100,000 women), [52] the successful implementation of a range of cost-effective strategies would likely be required over the longer term, potentially including primary prevention activities, further improvements in screening technologies, increased NBCSP screening and diagnostic assessment adherence (as considered here), and colorectal cancer treatment and survival improvements. We have estimated that the Australian government is estimated to spend more than AUD$1 billion annually to provide iFOBT screening, diagnostic assessment to follow-up positive iFOBT results and CRC treatment, [3] This estimated annual expenditure is broadly consistent with another Australian study.…”