Cervical Cancer Screening, HPV Vaccination, and Cervical Cancer Elimination

Abstract

Importance: To accelerate cervical cancer elimination, it is essential to evaluate the combined impact of ongoing screening and human papillomavirus (HPV) vaccination efforts, as the disease remains a significant global public health concern.

Objective: To estimate how different cervical cancer screening strategies, along with HPV vaccination, affect the cervical cancer burden in South Korea.

Design, setting, and participants: This decision analytical model used a deterministic age-structured dynamic model to simulate HPV transmission and cervical cancer progression, considering sexual behavior and population structure, for the Korean population from 2024 to 2100. The study was conducted from April 2023 to September 2024.

Exposures: Cervical cancer screening using Papanicolaou (Pap) or HPV testing, with HPV vaccination.

Main outcomes and measures: The cumulative number of incident cases of cervical cancer and deaths for the projected period are reported.

Results: The study modeled more than 51 million Korean residents, with 25.88 million women (50.1%) and 10.05 million women aged 18 to 49 years. Among Pap test-based strategies, biennial screening for women aged 20 years and older was associated with the lowest number of cervical cancer cases (47 358) and deaths (34 242) by 2100, with as much as a 10% mortality reduction compared with other Pap test-based strategies. High-risk HPV (hrHPV) testing every 2 or 3 years was estimated to further reduce cases by as much as 27% and deaths by 13%. Depending on the screening strategy, cervical cancer elimination based on the World Health Organization definition (4 cases per 100 000 women) could occur as early as 2038 (with 2-year hrHPV testing starting at age 25 years or older) or as late as 2055 (5-year Pap testing for individuals aged 25 to 64 years). The current screening policy (Pap test every 2 years starting at age 20 years) was estimated to reach disease elimination by 2044. In an ideal scenario with 70% screening and 90% vaccination coverage from 2030, an additional 12% of cases and 7% of deaths could be prevented. Strategies using a 2-year interval for hrHPV testing could lead to the earliest cervical cancer elimination by 2034.

Conclusions and relevance: In this decision analytical model, an ideal scenario with higher cervical cancer screening and HPV vaccination rates was associated with substantially reduced cervical cancer incidence and mortality and accelerated elimination in South Korea. Notably, hrHPV testing with 2- or 3-year screening intervals was estimated to achieve elimination as early as 2034.

Figure 1.. Age-Specific Prevalence of Human Papillomavirus (HPV) and Cervical Cancer, Projected By Model and Epidemiological Data

HR indicates high risk; KCCR, Korea Center Cancer Registry.

Figure 2.. Projected Timeframe to Cervical Cancer Elimination Under Current Screening Strategies in Korea

The realistic scenario uses the age-specific screening rate of 51.5% from the of the National Cancer Screening Program and the human papillomavirus (HPV) vaccination rate of 75% in adolescent girls. The ideal scenario uses the realistic scenario from 2024 to 2030, then from 2023, the screening rate increases to 70% and the HPV vaccination rate increases to 90% in adolescent girls. ASR indicates age-standardized rate.

Figure 3.. Difference in Time to Cervical Cancer Elimination Under Current Screening Strategies in Realistic Scenarios With Different Parameters

Current strategy is biennial Papanicolaou testing for women aged 20 years or older; the projected year of elimination is 2044. HPV indicates human papillomavirus; WHO, World Health Organization.