Early adoption of innovation in HPV prevention strategies: closing the gap in cervical cancer

Abstract

Cervical cancer (CC) is one of the highest prevailing causes of female cancer-related mortality globally. A significant discrepancy in incidence has been noted between high and low-middle-income countries. The origins of CC have been accredited to the human papillomavirus (HPV) with serotypes 16 and 18 being the most prevalent. HPV vaccines, with 90%-97% efficacy, have proven safe and currently function as the primary prevention method. In addition, secondary prevention by timely screening can potentially increase the 5-year survival rate by >90%. High-precision HPV DNA testing has proven to be both highly sensitive and specific for early detection and is advocated by the WHO. Lack of public awareness, poor screening infrastructure and access to vaccines, socio-cultural concerns, along with economic, workforce-associated barriers and the presence of marginalised communities unable to access services have contributed to a continued high incidence. This article comprehensively analyses the efficacy, coverage, benefits and cost-effectiveness of CC vaccines and screening strategies including the transition from cytological screening to HPV self-sampling, while simultaneously exploring the real-world disparities in their feasibility. Furthermore, it calls for the implementation of population-based approaches that address the obstacles faced in approaching the WHO 2030 targets for CC elimination.

Keywords: HPV; Pap; cervical cancer; elimination; population health; primary prevention; screening; secondary prevention; vaccine.

Figure 1.. This figure shows onco-pathogenesis of CC due to HPV.

Figure 2.. This figure is a conceptual diagram summarising the two main strategies for CC prevention.

Figure 3.. The world map above shows the available data for vaccination cover of the first dose of the HPV vaccine in girls till the year 2022 [22, 30] (The areas shaded in purple depicts the areas which have started vaccination programs from 2019, but do not have adequate national data available).