Streamlining the WHO cervical cancer elimination goal

• Published in: The lancet oncology Vol. 22; no. 11; pp. 1484 - 1485
• Main Authors: Harper, Diane M, Rozek, Laura S
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01.11.2021; Elsevier Limited
• Subjects: Biomarkers; Cervical cancer; Cervix; Cytology; Human papillomavirus; Immunization; Immunogenicity; Infections; Precision medicine; Vaccination; Vaccines; Womens health
• DOI: 10.1016/S1470-2045(21)00487-3
• ISSN: 1470-2045

Cervical cancer elimination is defined by WHO as reducing and maintaining the incidence of cervical cancer to less than four in 100 000 women.1,2 Although this rate was reached in Finland in 1990–95 with an organised annual cytology screening system, it could not be maintained.3 Science and technology has evolved substantially from a test relying on cellular morphology to a precision medicine approach, with human papillomavirus (HPV) vaccination targeted to the most aggressive HPV types and primary HPV testing with biomarker triage. Recent evidence has produced clinical management risk thresholds for cervical intraepithelial neoplasia grade 3 or worse (CIN3+), which call for immediate treatment above the highest threshold and lesser thresholds for reassurance and extended surveillance.4,5 The risk-based framework allows new technology to evolve within a standardised clinical guideline for management, bringing more precision, and thus efficiency, to global cervical cancer prevention. At a median follow-up of 9·0 years (IQR 8·2–9·6) after the single quadrivalent HPV vaccination, 47 women remained in the observation cohort from the original 2135 women who were assessed.6 In another study, Kreimer and colleagues provide evidence of both efficacy and immunogenicity over 11 years for 112 women after a single bivalent HPV vaccine dose.7 Both studies are limited by sample size and small underlying crude attack rates of type-specific HPV infections.