Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling study

摘要: Summary Background Cervical screening and human papillomavirus (HPV) vaccination have been implemented in most high-income countries; however, coverage is low low-income middle-income countries (LMICs). In 2018, the Director-General of WHO announced a call to action for elimination cervical cancer as public health problem. has called global scale-up vaccination, screening, treatment precancer, early detection prompt invasive cancers, palliative care. An threshold terms incidence not yet defined, but an absolute rate could be chosen such threshold. this study, we aimed quantify potential cumulative effect scaled up on number cases averted over 50 years from 2020 2069, predict outcomes beyond 2070 identify earliest by which rates drop below two levels that considered possible thresholds—the rare (six new per 100 000 women year, observed only few countries), lower four year. Methods statistical trends analysis modelling did existing worldwide using high-quality registry data included Cancer Incidence Five Continents series published International Agency Research Cancer. We then used comprehensive extensively validated simulation platform, Policy1-Cervix, do dynamic multicohort modelled impact scenarios prevention, order future burden cancer. Data are presented globally, Human Development Index (HDI) category, at individual country level. Findings absence further intervention, there would 44·4 million diagnosed globally period 2020–69, with almost two-thirds occurring low-HDI or medium-HDI countries. Rapid 80–100% broad-spectrum HPV vaccine avert 6·7–7·7 period, more than half these will after 2060. Implementation HPV-based twice lifetime age 35 45 all LMICs 70% bring forward effects prevention total 12·5–13·4 next years. combined high-coverage onwards result average annual declining less six individuals 2045–49 very-high-HDI countries, 2055–59 high-HDI 2065–69 2085–89 2070–79 2090–2100 However, achieved end century. If delivery gradually 2020–50 (eg, 20–45% 25–70% once-per-lifetime 2030, increasing 40–90% 90% 2050, when across HDI categories), century reduced lesser amount. scenario, decline 0·8 1·3 4·4 14 Interpretation More 44 if primary secondary programmes LMICs. high can quickly, substantial disease seen three decades, nearer-term require older cohorts who benefit vaccination. Widespread both achieve around year less, categories, A draft strategy accelerate elimination, goals targets 2020–30, World Health Assembly 2020. The findings here helped inform initial discussions targets, ongoing comparative other groups supporting development final elimination. Funding National Medical Council (NHMRC) Australia, part-funded via NHMRC Centre Excellence Control (C4; APP1135172).