Streamlining the WHO cervical cancer elimination goal
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 technolo...
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Published in | The lancet oncology Vol. 22; no. 11; pp. 1484 - 1485 |
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Main Authors | , |
Format | Journal Article |
Language | English |
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Elsevier Ltd
01.11.2021
Elsevier Limited |
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Abstract | 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. |
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AbstractList | 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. |
Author | Rozek, Laura S Harper, Diane M |
Author_xml | – sequence: 1 givenname: Diane M surname: Harper fullname: Harper, Diane M email: harperdi@med.umich.edu organization: Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109-0944, USA – sequence: 2 givenname: Laura S surname: Rozek fullname: Rozek, Laura S organization: School of Public Health, University of Michigan, Ann Arbor, MI 48109-0944, USA |
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Cites_doi | 10.1093/jnci/djaa011 10.1016/j.eclinm.2020.100401 10.1016/S1470-2045(21)00453-8 10.1158/1055-9965.EPI-16-0787 10.1016/S1473-3099(10)70182-1 10.1158/1055-9965.EPI-17-0534 10.1016/S0140-6736(20)30068-4 10.1016/j.vaccine.2018.02.087 10.1097/LGT.0000000000000529 |
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References | (bib2) July 6, 2021 Kreimer, Sampson, Porras (bib7) 2020; 112 Sankaranarayanan, Joshi, Muwonge (bib8) 2018; 36 Egemen, Cheung, Chen (bib5) 2020; 24 Basu, Malvi, Joshi (bib6) 2021 Kjaer, Nygård, Sundström (bib9) 2020; 23 Harper, Nieminen, Paavonen, Lehtinen (bib3) 2010; 10 Stanczuk, Baxter, Currie (bib4) 2017; 26 Campos, Jeronimo, Tsu, Castle, Mvundura, Kim (bib10) 2017; 26 Brisson, Kim, Canfell (bib1) 2020; 395 Brisson (10.1016/S1470-2045(21)00487-3_bib1) 2020; 395 Stanczuk (10.1016/S1470-2045(21)00487-3_bib4) 2017; 26 Kreimer (10.1016/S1470-2045(21)00487-3_bib7) 2020; 112 Egemen (10.1016/S1470-2045(21)00487-3_bib5) 2020; 24 Sankaranarayanan (10.1016/S1470-2045(21)00487-3_bib8) 2018; 36 Kjaer (10.1016/S1470-2045(21)00487-3_bib9) 2020; 23 Campos (10.1016/S1470-2045(21)00487-3_bib10) 2017; 26 Harper (10.1016/S1470-2045(21)00487-3_bib3) 2010; 10 Basu (10.1016/S1470-2045(21)00487-3_bib6) 2021 |
References_xml | – volume: 26 start-page: 1500 year: 2017 end-page: 1510 ident: bib10 article-title: The cost-effectiveness of visual triage of human papillomavirus-positive women in three low- and middle-income countries publication-title: Cancer Epidemiol Biomarkers Prev contributor: fullname: Kim – year: 2021 ident: bib6 article-title: Vaccine efficacy against persistent human papillomavirus (HPV) 16/18 infection at 10 years after one, two, and three doses of quadrivalent HPV vaccine in girls in India: a multicentre, prospective, cohort study publication-title: Lancet Oncol contributor: fullname: Joshi – year: July 6, 2021 ident: bib2 article-title: New recommendations for screening and treatment to prevent cervical cancer – volume: 10 start-page: 594 year: 2010 end-page: 595 ident: bib3 article-title: Cervical cancer incidence can increase despite HPV vaccination publication-title: Lancet Infect Dis contributor: fullname: Lehtinen – volume: 395 start-page: 575 year: 2020 end-page: 590 ident: bib1 article-title: Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries publication-title: Lancet contributor: fullname: Canfell – volume: 112 start-page: 1038 year: 2020 end-page: 1046 ident: bib7 article-title: Evaluation of durability of a single dose of the bivalent HPV vaccine: the CVT trial publication-title: J Natl Cancer Inst contributor: fullname: Porras – volume: 36 start-page: 4783 year: 2018 end-page: 4791 ident: bib8 article-title: Can a single dose of human papillomavirus (HPV) vaccine prevent cervical cancer? Early findings from an Indian study publication-title: Vaccine contributor: fullname: Muwonge – volume: 26 start-page: 1629 year: 2017 end-page: 1635 ident: bib4 article-title: Defining optimal triage strategies for hrhpv screen-positive women-an evaluation of HPV 16/18 genotyping, cytology, and p16/Ki-67 cytoimmunochemistry publication-title: Cancer Epidemiol Biomarkers Prev contributor: fullname: Currie – volume: 23 year: 2020 ident: bib9 article-title: Final analysis of a 14-year long-term follow-up study of the effectiveness and immunogenicity of the quadrivalent human papillomavirus vaccine in women from four Nordic countries publication-title: EClinicalMedicine contributor: fullname: Sundström – volume: 24 start-page: 132 year: 2020 end-page: 143 ident: bib5 article-title: Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines publication-title: J Low Genit Tract Dis contributor: fullname: Chen – volume: 112 start-page: 1038 year: 2020 ident: 10.1016/S1470-2045(21)00487-3_bib7 article-title: Evaluation of durability of a single dose of the bivalent HPV vaccine: the CVT trial publication-title: J Natl Cancer Inst doi: 10.1093/jnci/djaa011 contributor: fullname: Kreimer – volume: 23 year: 2020 ident: 10.1016/S1470-2045(21)00487-3_bib9 article-title: Final analysis of a 14-year long-term follow-up study of the effectiveness and immunogenicity of the quadrivalent human papillomavirus vaccine in women from four Nordic countries publication-title: EClinicalMedicine doi: 10.1016/j.eclinm.2020.100401 contributor: fullname: Kjaer – year: 2021 ident: 10.1016/S1470-2045(21)00487-3_bib6 article-title: Vaccine efficacy against persistent human papillomavirus (HPV) 16/18 infection at 10 years after one, two, and three doses of quadrivalent HPV vaccine in girls in India: a multicentre, prospective, cohort study publication-title: Lancet Oncol doi: 10.1016/S1470-2045(21)00453-8 contributor: fullname: Basu – volume: 26 start-page: 1500 year: 2017 ident: 10.1016/S1470-2045(21)00487-3_bib10 article-title: The cost-effectiveness of visual triage of human papillomavirus-positive women in three low- and middle-income countries publication-title: Cancer Epidemiol Biomarkers Prev doi: 10.1158/1055-9965.EPI-16-0787 contributor: fullname: Campos – volume: 10 start-page: 594 year: 2010 ident: 10.1016/S1470-2045(21)00487-3_bib3 article-title: Cervical cancer incidence can increase despite HPV vaccination publication-title: Lancet Infect Dis doi: 10.1016/S1473-3099(10)70182-1 contributor: fullname: Harper – volume: 26 start-page: 1629 year: 2017 ident: 10.1016/S1470-2045(21)00487-3_bib4 article-title: Defining optimal triage strategies for hrhpv screen-positive women-an evaluation of HPV 16/18 genotyping, cytology, and p16/Ki-67 cytoimmunochemistry publication-title: Cancer Epidemiol Biomarkers Prev doi: 10.1158/1055-9965.EPI-17-0534 contributor: fullname: Stanczuk – volume: 395 start-page: 575 year: 2020 ident: 10.1016/S1470-2045(21)00487-3_bib1 article-title: Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries publication-title: Lancet doi: 10.1016/S0140-6736(20)30068-4 contributor: fullname: Brisson – volume: 36 start-page: 4783 year: 2018 ident: 10.1016/S1470-2045(21)00487-3_bib8 article-title: Can a single dose of human papillomavirus (HPV) vaccine prevent cervical cancer? Early findings from an Indian study publication-title: Vaccine doi: 10.1016/j.vaccine.2018.02.087 contributor: fullname: Sankaranarayanan – volume: 24 start-page: 132 year: 2020 ident: 10.1016/S1470-2045(21)00487-3_bib5 article-title: Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines publication-title: J Low Genit Tract Dis doi: 10.1097/LGT.0000000000000529 contributor: fullname: Egemen |
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Snippet | 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... |
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SubjectTerms | Biomarkers Cervical cancer Cervix Cytology Human papillomavirus Immunization Immunogenicity Infections Precision medicine Vaccination Vaccines Womens health |
Title | Streamlining the WHO cervical cancer elimination goal |
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