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. 2021 Jul;6(7):e510-e521.
doi: 10.1016/S2468-2667(21)00046-3. Epub 2021 Apr 15.

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

Maxime Bonjour  1 , Hadrien Charvat  2 , Eduardo L Franco  3 , Marion Piñeros  2 , Gary M Clifford  4 , Freddie Bray  2 , Iacopo Baussano  5
Affiliations

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

Maxime Bonjour et al. Lancet Public Health. 2021 Jul.

Abstract

Background: WHO has launched an initiative aiming to eliminate cervical cancer as a public health problem. Elimination is a long-term target that needs long-lasting commitment. To support local authorities in implementing human papillomavirus (HPV) vaccination, we provide regional and country-specific estimates of cervical cancer burden and the projected impact of HPV vaccination among today's young girls who could develop cervical cancer if not vaccinated.

Methods: The expected number of cervical cancer cases in the absence of vaccination among girls born between 2005 and 2014 was quantified by combining age-specific incidence rates from GLOBOCAN 2018 and cohort-specific mortality rates by age from UN demographic projections. Preventable cancers were estimated on the basis of HPV prevalence reduction attributable to vaccination and the relative contribution of each HPV type to cervical cancer incidence. We assessed the number of cervical cancer cases preventable through vaccines targeting HPV types 16 and 18, with and without cross-protection, and through vaccines targeting HPV types 16, 18, 31, 33, 45, 52, and 58.

Findings: Globally, without vaccination, the burden of cervical cancer in these birth cohorts is expected to reach 11·6 million (95% uncertainty interval 11·4-12·0) cases by 2094. Approximately 75% of the burden will be concentrated in 25 countries mostly located in Africa and Asia, where the future number of cases is expected to increase manyfold, reaching 5·6 million (5·4-6·0) cases in Africa and 4·5 million (4·4-4·6) cases in Asia. Worldwide immunisation with an HPV vaccine targeted to HPV types 16 and 18, with cross-protection against HPV types 31, 33, and 45, could prevent about 8·7 million (8·5-9·0) cases.

Interpretation: Detailed estimates of the increasing burden of cervical cancer and projected impact of HPV vaccination is of immediate relevance to public health decision makers. Shifting the focus of projections towards recently born girls who could develop cervical cancer if not vaccinated is fundamental to overcome stakeholders' hesitancy towards HPV vaccination.

Funding: Bill & Melinda Gates Foundation, Canadian Institutes of Health Research.

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Conflict of interest statement

Declaration of interests ELF has received grants to his university and personal fees from Merck, outside of the submitted work. ELF has a patent “Methylation markers in cervical cancer” pending to his university. The other authors declare no competing interests.

Figures

Figure 1
Figure 1
Number of cervical cancer cases (A) and lifetime incidence (B) expected among women born between 2005 and 2014, by country NA=not applicable.
Figure 2
Figure 2
Country-specific numbers of cervical cancer cases expected among women born between 2005 and 2014 in the absence of vaccination and preventable through vaccination programmes Countries are grouped according to their contribution to the overall cervical cancer burden, with countries sorted according to the expected number of cervical cancer cases and subsequently grouped into the following five categories: very high burden (accounting for up to 50% of all cancer cases worldwide), high burden (accounting for the next 25% of all cases), medium burden (accounting for the next 15%), low burden (accounting for the next 9%), and very low burden (accounting for the remaining 1%).
Figure 2
Figure 2
Country-specific numbers of cervical cancer cases expected among women born between 2005 and 2014 in the absence of vaccination and preventable through vaccination programmes Countries are grouped according to their contribution to the overall cervical cancer burden, with countries sorted according to the expected number of cervical cancer cases and subsequently grouped into the following five categories: very high burden (accounting for up to 50% of all cancer cases worldwide), high burden (accounting for the next 25% of all cases), medium burden (accounting for the next 15%), low burden (accounting for the next 9%), and very low burden (accounting for the remaining 1%).
Figure 2
Figure 2
Country-specific numbers of cervical cancer cases expected among women born between 2005 and 2014 in the absence of vaccination and preventable through vaccination programmes Countries are grouped according to their contribution to the overall cervical cancer burden, with countries sorted according to the expected number of cervical cancer cases and subsequently grouped into the following five categories: very high burden (accounting for up to 50% of all cancer cases worldwide), high burden (accounting for the next 25% of all cases), medium burden (accounting for the next 15%), low burden (accounting for the next 9%), and very low burden (accounting for the remaining 1%).
Figure 3
Figure 3
Ratio of the average number of expected cervical cancer cases across birth cohorts born between 2005 and 2014 in the absence of vaccination versus the total number of cases estimated in 2018 NA=not applicable.
Figure 4
Figure 4
Age-specific distribution of average number of expected cervical cancer cases across birth cohorts born between 2005 and 2014 in the absence of vaccination, compared with those estimated in 2018, by continent
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