Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries
- Study type
- Other
- Study name
- WHO CCEMC
- Design
- Comparative modelling analysis using three independent dynamic models (the WHO Cervical Cancer Elimination Modelling Consortium, CCEMC) of HPV infection, cervical carcinogenesis, screening and treatment of precancerous lesions and invasive cancer
- Sample size
- 78 low-income and lower-middle-income countries (modelling study; no patient enrolment)
- Source
- The Lancet · 2020
In plain words
This study used computers and mathematical models to work out how many deaths from cervical cancer would be prevented if low-income and lower-middle-income countries expanded HPV vaccination, cervical screening and cancer treatment well. It found that vaccination has little effect on deaths in the short term, but together with screening and treatment it would cut deaths by about one third by 2030. In the long term (by 2120), the programme could lower deaths by almost 99% and save the lives of more than 62 million women. These results are model predictions, not the result of a trial in patients.
Key results
Treatment arms and regimens
Vaccination of girls only at age 9 years, with catch-up vaccination for girls aged 10 to 14 years. The vaccine was assumed to give 100% lifetime protection against infection with HPV types 16, 18, 31, 33, 45, 52 and 58, with coverage reaching 90% in 2020.
Girls' vaccination as in scenario 1, plus cervical screening with HPV testing at age 35 years (once in a lifetime) and scale-up of cancer treatment. Screening coverage reaches 45% by 2023, 70% by 2030 and 90% by 2045. It was assumed that 50% of women with invasive cervical cancer would receive appropriate surgery, radiotherapy and chemotherapy by 2023, rising to 90% by 2030.
Girls' vaccination as in scenario 1, plus cervical screening with HPV testing at ages 35 and 45 years (twice in a lifetime) and scale-up of cancer treatment with the same coverage timeline as scenario 2 (screening: 45% by 2023, 70% by 2030, 90% by 2045; appropriate treatment of invasive cancer: 50% by 2023 and 90% by 2030). This scenario matches the WHO 90-70-90 triple-intervention strategy.
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
The female population of 78 low-income and lower-middle-income countries (LMICs). This is a modelling study and no patients were enrolled.
Endpoints
Primary endpoint: reduction in age-standardised cervical cancer mortality rates and number of deaths averted over the next century in 78 low-income and lower-middle-income countries, compared with the status quo. The potential of the cervical cancer elimination initiative to support UN Sustainable Development Goal target 3.4 (a one-third reduction in premature mortality from non-communicable diseases by 2030) was also examined. Results are presented as the median (range) of the model predictions.
Safety and side effects
This is a modelling study, and safety outcomes or adverse events are not reported in the abstract.
Clinical significance and place in guidelines
This modelling analysis supports the WHO cervical cancer elimination strategy (90-70-90 targets by 2030) and shows that vaccination, screening and treatment must be implemented together, because the effect of vaccination alone on mortality by 2030 is minimal. The greatest benefit would be in sub-Saharan Africa and South Asia. According to the abstract, full implementation of the strategy could help achieve Sustainable Development Goal target 3.4. The exact status of this strategy in formal guidelines should be checked in WHO sources.
Limitations
The results are based on modelling and on assumptions stated in the abstract, including 100% lifetime vaccine protection against specified HPV types, achievement of 90% vaccination coverage in 2020, and the timing of the scale-up of screening and treatment. Realising these results depends on actually achieving these coverage levels. Other limitations are not stated in the abstract and the full text should be consulted.
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.