Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries
- Study type
- Other
- Study name
- WHO CCEMC
- Design
- Comparative modelling study with three independent transmission-dynamic models (WHO Cervical Cancer Elimination Modelling Consortium)
- Sample size
- Modelling in 78 low-income and lower-middle-income countries (no real patients)
- Source
- The Lancet · 2020
In plain words
This study used computer modelling to look at how HPV vaccination and screening could reduce cervical cancer in low-income and lower-middle-income countries. It found that if most girls are vaccinated, cervical cancer will fall sharply in most of these countries by the end of this century, and millions of cancers will be prevented. Adding screening with an HPV test in adulthood speeds this up and will be essential in countries with the highest burden of disease. This is a prediction from modelling, not the result of a trial in patients.
Key results
Treatment arms and regimens
HPV vaccination of girls at age 9 (with catch-up vaccination up to age 14), assuming 90% coverage and 100% lifelong protection against HPV types 16, 18, 31, 33, 45, 52 and 58.
Vaccination as in scenario 1, plus once-lifetime screening with an HPV test. Screening uptake increased from 45% (2023) to 90% (2045 onwards).
Vaccination as in scenario 1, plus twice-lifetime screening with an HPV test at ages 35 and 45. Uptake increased from 45% (2023) to 90% (2045 onwards).
Source of the regimen details: Abstract of the paper
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
Simulated populations in 78 low-income and lower-middle-income countries. Girls were vaccinated at age 9 (with catch-up vaccination up to age 14).
Endpoints
Feasibility and timing of cervical cancer elimination at different thresholds, and the number of cervical cancer cases averted on the way to elimination. Elimination thresholds: mean age-standardised incidence ≤4 cases per 100,000 woman-years, ≤10 cases per 100,000 woman-years, and an incidence reduction of ≥85%.
Safety and side effects
This is a modelling study, and the abstract reports no safety or adverse-event data.
Clinical significance and place in guidelines
According to the abstract, three independent models consistently showed that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most low-income and lower-middle-income countries by the end of the century, and that screening with high uptake speeds up elimination. These findings support the WHO cervical cancer elimination targets. The status of recommendations in formal guidelines should be checked separately, as the abstract does not mention it.
Limitations
The results are based on modelling and standardised assumptions, including 90% vaccination coverage, 100% lifelong vaccine protection and an increase in screening uptake to 90%. The abstract stresses that elimination depends on long-term vaccine protection. Results are reported as ranges of model predictions (some ranges are wide, such as 37 to 99% for the ≥85% reduction threshold with vaccination alone). This study does not provide observational clinical data.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.