A Historic Milestone: We Are Eliminating Cervical Cancer with HPV Vaccination!
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One recent oncology study stands out. It is among the most remarkable pieces of research we have seen in this field for a long time. Journal of the National Cancer Institute published the study on January 22, 2024, under the title "Bivalent Human Papillomavirus Vaccination Following Invasive Cervical Cancer Incidence: A Population-Based Observational Study of Age at Immunization, Dose, and Deprivation." In short, it is an observational study of cervical cancer incidence following the bivalent HPV vaccine .
I want to emphasize the importance of these findings, particularly for young people. They are vital for women in relation to cervical cancer and other HPV-associated cancers.
Cervical cancer develops through uncontrolled growth of cells in the cervix. It is one of the most common cancers in women worldwide and is particularly prevalent in Africa, Latin America and the Middle East.
According to the World Health Organization (WHO), 70 percent of cervical cancer deaths in 2018 occurred in developing countries. WHO also reports that in 2020, cervical cancer was the 7th most common cancer, with 604 thousand new cases, accounting for 3.1% of all new cancers. Türkiye Cancer Statistics 2020 reports 2,532 new cases annually, making cervical cancer the 18th most common cancer in Türkiye. There were 1,245 deaths from it that year.
Details of the Scottish Study
This Scottish population-based observational study followed all screening-eligible women born between 1988 and 1996, a large population of 450,000.
Importantly, 40,000 women had been vaccinated at ages 12 to 13. This was in the past: these 40,000 vaccinated women were then followed. There were also 124,000 women vaccinated at age 14 or older, while 300,000 were unvaccinated.
This was not a prospective controlled trial but concrete, real-world population data, useful for learning whether a preventive vaccine works.
Related topic: Cervical Cancer Precursors: What Are CIN1, CIN2 and CIN3? Can Progression to Cancer Be Prevented?
Zero Cases!
The crucial point: there were no cases!
There were zero cervical cancer cases among the 40,000 women vaccinated before age 14.
This means complete prevention in this population, including women who received only one or two doses. We may be learning that three doses are not even necessary. The protocol called for three, but there were no cases among the 40,000 women vaccinated before 14.
Women vaccinated between ages 14 and 22 also benefited substantially. Compared with 3.2 cases per 100,000 women, the unvaccinated group had 8.4 cases. This meant a two-and-a-half-fold lower risk than in unvaccinated women, demonstrating benefit in that population.
Again, if vaccination generally occurs before sexual activity begins, complete eradication of cervical cancer is possible.
This is not the only study showing such findings. Its careful analysis and long-term follow-up provide population data suggesting that vaccination before sexual activity can almost entirely—or indeed entirely—eliminate cervical cancer.
If you are a parent, pediatrician or family doctor, I strongly recommend considering this information. As an oncologist, I am now convinced that cervical cancer can be almost eliminated. Vaccinating young people can make it happen.
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HPV Causes More Than 95% of Cervical Cancers
HPV (Human Papilloma Virus) is the most commonly sexually transmitted virus and the leading cause of cervical cancer. It causes cervical cell changes that may become cancerous over time.
Key facts about HPV and cervical cancer:
- Most HPV infections are cleared by the immune system and do not cause cervical cancer.
- Approximately 0.8% of chronic cervical HPV infections become cancerous over 20-30 years.
- Around 40 HPV types infect humans. Some cause cervical cancer, so women exposed to those types have higher risk.
- Types 16 and 18 are considered the highest-risk causes. Types 31, 33, 45, 52 and 58 may also cause cervical cancer.
- This risk can therefore be reduced through HPV vaccines . There are 3 types: 2-valent, 4-valent and 9-valent.
- Early detection is important because cervical cancer is treatable. Regular screening is therefore recommended.
- Screening includes Pap smear testing and HPV screening .
- A Pap smear examines a cervical sample; abnormal cells prompt further assessment. HPV screening detects certain types associated with cervical cancer.
- Screening and HPV vaccination are ways to protect against cervical cancer.
- Women should begin screening at 25 and have HPV testing every 5 years until 65. If HPV testing is unavailable, people aged 25 to 65 should have cotesting (smear plus HPV testing) every 5 years or a smear alone every 3 years.
- HPV vaccination protects against cervical-cancer-associated types and is recommended for children aged 11-12 and adults younger than 26. The 9-valent vaccine can be given up to age 45.
- The 4-valent and 9-valent vaccines are available in Türkiye.
- HPV vaccination has substantially reduced cervical cancer incidence and is highly effective. Australia, the most successful country in implementing vaccination across its population, is progressing steadily toward elimination.
- HPV causes not only cervical cancer but 6% of all cancers. It can also cause cancers of the anus, penis, pharynx, mouth, throat, vagina and breast.
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