Cost-effectiveness of HPV vaccination in the context of high cervical cancer incidence and low screening coverage

Abstract Background Cervical cancer incidence is influenced by screening and risk factors in the population. The main risk factor for cervical cancer is sexually transmitted human papillomavirus (HPV), which is sexually transmitted and thus associated with sexual behavior. Smoking, parity and hormonal contraceptive use may also be associated with cervical cancer risk. We compared incidence, screening coverage and risk behaviors for cervical cancer between health regions in Norway. Methods We obtained data on incidence of cervical cancer among Norwegian women during 1992–2016 and data on screening coverage from the Cancer Registry of Norway. We obtained data on sexual behavior and smoking from a population-based survey of 16,575 Norwegian women who were 18–45 years old in 2005. Results Cervical cancer incidence was higher in the northern and southeastern region than in the middle and western region (range in incidence per 100,000 person-years during 1992–2016; north: 10.5 to 14.6; southeast: 9.3 to 12.9; mid: 6.8 to 9.5; west: 8.4 to 10.0). The incidence decreased modestly in the north (average annual percentage change (95% confidence interval) − 1.0 (− 1.2 to − 0.7)) and southeast (− 0.7 (− 1.0 to − 0.3)), but did not change significantly in the mid (− 0.3 (− 1.0 to 0.4)) and west (− 0.3 (− 0.6 to 0.0)). Compared to the national average, women in the north had earlier sexual debut, more partners and higher prevalence of ever having had a sexually transmitted infection (STI), while the opposite was observed among women in the west. Women in the middle and southeastern regions tended to be similar to the national average for sexual behaviors. Although less pronounced, the prevalence of smoking showed regional patterns similar to that observed for sexual behaviors, while ever-use of hormonal contraceptives and cervical screening coverage was similar between regions. Conclusions There were regional differences in cervical cancer incidence during the era of nationally organized cervical screening in Norway. To some extent, these differences corresponded to regional differences in risk behavior for cervical cancer in the Norwegian female population.

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Potential for cervical cancer incidence and death resulting from Japan’s current policy of prolonged suspension of its governmental recommendation of the HPV vaccine

Scientific Reports ◽

10.1038/s41598-020-73106-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Asami Yagi ◽

Yutaka Ueda ◽

Satoshi Nakagawa ◽

Sayaka Ikeda ◽

Yusuke Tanaka ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Incidence ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Policy Decision ◽

Daily Basis ◽

Vaccination Rate ◽

Cervical Cancer Incidence ◽

Temporary Suspension ◽

The Government

Abstract In 2013, recurrent reports of diverse symptoms occurring in girls after receiving HPV vaccination appeared in Japanese media. The Ministry of Health, Labor and Welfare quickly responded by announcing a temporary suspension of its recommendation for the vaccine. The HPV vaccination rate soon fell to almost zero. In the present study, we calculated the potential future numbers of cervical cancer incidence and death that will be increased by this policy decision. We have assumed that the number of yearly vaccinations is evenly distributed across a daily basis. Future incidence and death increased in females born in FY2000 are estimated to be 3651 and 904, respectively, 4566 and 1130 for those born in FY2001, 4645 and 1150 for those born in FY2002, and 4657 and 1153 for those born in FY2003. In FY2020, the large increase of risks to females born in FY2004 amounts to 12.0 females per day who will now be at a higher risk for acquiring of cervical cancer in their future, and 3.0 females per day newly at risk for future death from that disease in its progressive form. No one should be able to accept this situation. We sincerely ask the government to resume its recommendation for the vaccine as soon as possible.

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Impact of screening on cervical cancer incidence in England: a time trend analysis

BMJ Open ◽

10.1136/bmjopen-2018-026292 ◽

2019 ◽

Vol 9 (1) ◽

pp. e026292 ◽

Cited By ~ 3

Author(s):

Francesca Pesola ◽

Peter Sasieni

Keyword(s):

Cervical Cancer ◽

Trend Analysis ◽

Cancer Incidence ◽

Cervical Screening ◽

Hpv Vaccination ◽

Cervical Cancer Incidence ◽

Incidence Data ◽

Cancer Registry Data ◽

Current Scenario ◽

The Impact

ObjectivesTo better model underlying trends in cervical cancer incidence so as to model past trends, to estimate the impact of cervical screening on cervical cancer rates at different ages and to obtain a counterfactual baseline under a no-screening scenario.DesignTrend analysis of cancer registry data recorded between 1971 and 2013.SettingEngland.Participants132 493 women aged 20–84 with a diagnosis of cervical cancer.Outcome measureCervical cancer incidence data were modelled using a modified age period cohort model able to capture both increased exposure to human papillomavirus (HPV) as well as changes in the age of exposure to HPV in young cohorts. Observed rates were compared with counterfactual baseline rates under a no-screening scenario to estimate the protective effect of screening.ResultsRates of cervical cancer incidence have been decreasing since the introduction of screening but are projected to increase in the future under the current scenario. Between 1988 and 2013, it was estimated that screening had prevented approximately 65 000 cancers. Moreover, in 2013, the age-standardised rate (ASR) estimated under the no-screening scenario (37.9, 95% CI 37.4 to 38.3) was threefold higher among women aged 20–84 than the observed ASR (12.8, 95% CI 12.3 to 13.3). We estimate that the age of first HPV exposure has decreased by about 1 year every decade since the early 1970s (women born in 1955 onwards).ConclusionsOur results corroborated the importance of screening in preventing cervical cancer and indicated future rates are dependent on age at HPV exposure. Estimated future rates can be used for healthcare planning while the counterfactual baseline to quantify the impact of HPV vaccination in microsimulations.

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