[Articles] Global estimates of expected and preventable cervical cancers among girls born between 2005 and 2014: a birth cohort analysis

Research in context

Evidence before this study

WHO has launched a global initiative aiming to eliminate cervical cancer as a public health problem. Scaling up in all countries of vaccination, screening, and precancer treatment, in addition to invasive cancer treatment and palliative care, underpins the global elimination strategy. We searched PubMed for studies published from Jan 1, 2000, to Nov 30, 2020, with the search terms “cervical cancer” or “human papillomavirus” or “HPV” and “elimination” and “model” or “modelling”. Four studies were retained out of 226 identified references. Findings from these studies suggest that widespread coverage of both human papillomavirus (HPV) vaccination and cervical screening has the potential to avert about 13 million cervical cancer cases by 2069. The reported findings also suggest that cervical cancer elimination might be attainable within a few decades in high-income countries but will take longer in low-income and middle-income countries (LMICs), and will be achieved towards the end of the 21st century in a number of sub-Saharan African countries where rates are currently the highest worldwide. However, by mid-2019, only 96 countries, mostly high income, had introduced HPV vaccination. The reported coverage of target birth cohorts is currently unequal throughout the world and, for many countries, often considerably lower than the recommended threshold of 90%. Therefore, worldwide efforts to bolster implementation and scale-up of vaccination programmes are essential, particularly considering that HPV vaccination is highly cost-effective, as recently confirmed by an updated global assessment done with the Papillomavirus Rapid Interface for Modelling and Economics.

Added value of this study

At a local level, public health decision makers need predictions targeted to today's girls and young women at an eligible age for HPV vaccination to inform and frame their vaccination plans. This analysis assesses the expected burden of cervical cancer in the absence of HPV vaccination and the impact of vaccination from the perspective of women born between 2005 and 2014, who could expect to be protected against cervical cancer during their lifespan. We have focused our attention on cohort-specific cervical cancer burden as it is an indicator of direct relevance to decision makers wanting to assess the risk to today's young girls at an eligible age for HPV vaccination. Public health authorities, particularly in LMICs, are facing multiple obstacles, such as vaccine supply shortage, budgetary constraints, and vaccine hesitancy, to implementing and scaling up HPV vaccination as a component of their national expanded programme of immunisation. Our regional and country-specific estimates could provide key stakeholders with clear information to reinforce commitment and overcome reluctance towards HPV vaccination.

Implications of all the available evidence

Recent modelling exercises have shown that global cervical cancer elimination is a long-term target that will be achieved by scaling up vaccination, screening, and treatment of precancers and invasive cancers. Therefore, at a local level, to aim at elimination, it is essential to ensure long-lasting commitment to the allocation of adequate resources. Durable political and financial commitment towards HPV vaccination is effectively supported by the direct quantification of its impact on cervical cancer burden among today's girls and young women.

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