Scientific approaches toward improving cervical cancer elimination strategies

• Published in: International journal of cancer 2024-05, Vol.154 (9), p.1537-1548
• Main Authors: Lehtinen, Matti, Bruni, Laia, Elfström, Miriam, Gray, Penelope, Logel, Margaret, Mariz, Filipe Colaço, Baussano, Iacopo, Vänskä, Simopekka, Franco, Eduardo L., Dillner, Joakim
• Format: Article
• Language: English
• Subjects: Cancer therapies; Cervical cancer; Cervix; Coronaviruses; Cost analysis; Gender; gender‐neutral; Hepatitis B; HPV; Human papillomavirus; Immunization; Medical screening; Medicin och hälsovetenskap; population immunity; Reproductive health; screening; vaccination; Womens health
• ISSN: 0020-7136; 1097-0215; 1097-0215
• DOI: 10.1002/ijc.34839

At the 2023 EUROGIN workshop scientific basis for strategies to accelerate the elimination of cervical cancer and its causative agent, human papillomavirus (HPV) were reviewed. Although some countries have reached key performance indicators toward elimination (>90% of girls HPV vaccinated and >70% of women HPV screened), most are yet to reach these targets, implying a need for improved strategies. Gender‐neutral vaccination, even with moderate vaccination coverage was highlighted as a strategy to achieve elimination more rapidly. It is more resilient against major disturbances in vaccination delivery, such as what happened during the coronavirus pandemic. Further, an analysis of ethical/legal issues indicated that female‐restricted vaccination is problematic. Extended catch‐up of vaccination with concomitant screening, and outreach to vulnerable groups were highlighted. Although birth cohorts with high coverage of HPV vaccination at school are protected against HPV, and HPVs have a very low reproductive rate in women above age 35, adult women below age 30 have inadequate direct protection. In addition to herd protection from gender‐neutral vaccination, this group can be protected by offering concomitant catch‐up HPV vaccination and HPV screening. Furthermore, hepatitis B vaccination experiences indicate that elimination cannot be achieved without prioritizing vulnerable/migrant populations. The long‐lasting durability of vaccination‐induced antibody responses suggests prolonged protection with HPV vaccines when adequately administrated. Finally, cost‐effectiveness modelling suggests that high‐coverage HPV vaccination in multiple population segments will be resource‐saving due to reduced need for screening. In summary, the workshop found that strategically optimal deployment of vaccination will accelerate elimination of HPV and cervical cancer. What's new? Although some countries have reached key performance indicators toward the elimination of cervical cancer and its causative agent, human papillomavirus, most are yet to reach the vaccination and screening targets. The scientific basis for strategies to accelerate the elimination of cervical cancer was recently reviewed at a dedicated 2023 EUropean Research Organization on Genital Infection and Neoplasia (EUROGIN) workshop. The reviewed evidence suggests that strategies with more ambitious use of human papillomavirus vaccines (gender‐neutral vaccination or concomitant vaccination and screening) would accel