Cervical Cancer Protection in Japan: Where Are We?

Asami Yagi,Satoshi Nakagawa,Kosuke Hiramatsu,Sosuke Adachi,Yukio Suzuki,Tadashi Kimura,Mamoru Kakuda,Akiko Sukegawa,Masayuki Sekine,Takayuki Enomoto,Risa Kudo,Sayaka Ikeda,Toshihiro Kimura,Megumi Kurosawa,Yutaka Ueda,Etsuko Miyagi,Eiji Kobayashi,Manako Yamaguchi,Ai Miyoshi

doi:10.3390/vaccines9111263

Asami Yagi, Satoshi Nakagawa + Show 17 more

Open Access

https://doi.org/10.3390/vaccines9111263

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Abstract

In Japan, government subsidies for human papillomavirus (HPV) vaccination of girls aged 13–16 commenced in 2010. By early 2013, vaccination had become a widely accepted national immunization program. However, in June of 2013, the Ministry of Health, Labor, and Welfare (MHLW), the government’s lead agency, suspended its recommendation for vaccination in response to reports of adverse vaccine events. The rate of HPV vaccination quickly dropped from 70% to almost zero, where it has lingered for eight years. In 2020, a new 9-valent HPV vaccine was licensed in Japan. The momentum seemed to be building for the resumption of HPV vaccinations, yet Japanese mothers remain widely hesitant about vaccinating their daughters, despite the well-proven safety and efficacy of the HPV vaccines. The Japanese government and our educational and medical institutions must work harder as a team to inform our parents and their children about the life-saving benefits of the HPV vaccine, and at the same time, we must respond to all their concerns and questions. The vaccine hesitancy of unvaccinated women born in 2000 and thereafter is a natural consequence of the suspension of the government‘s recommendation. We must also take every possible measure to reduce the significant risk for cervical cancer these women have.

Highlights

Cervical cancer is one of the most common cancers for women
The World Health Organization (WHO) has noted that the burden of cervical cancer typically falls most heavily on women who lack proper access to health services, mainly those in low-and middle-income countries [2], it is disconcerting that among the most developed countries of the world, Japan’s incidence rate of cervical cancer has been accelerating since 2000 (Age-adjusted rate: 28.0 in 1976, 9.1 in 2000, 14.1 in 2012, Annual percent change in 2000–2012: 3.8) [3], a trend not seen in any other advanced country
In 2018, Luostarinen et al were the first to report on evidence obtained from an intention-to-treat trial showing that human papillomavirus vaccination (HPV) vaccination strongly protects against HPVassociated invasive cervical cancer [30]

Summary

Introduction

Cervical cancer is one of the most common cancers for women. In 2020, an estimated 600,000 women were diagnosed with cervical cancer worldwide, and about 341,000 deaths were attributed to it [1]. Abbereviations: human papillomavirus, HPV; Vaccine Adverse Reactions Review Committee, VARRC; Ministry of Health, Labor, and Welfare, MHLW Those were the ‘good old days’ when vaccination rates for girls of targeted age groups approached 70% compliance. On the 14th of June 2013, Japan’s Ministry of Health, Labor, and Welfare (MHLW) decided to temporarily suspend the national immunization program’s recommendation for routine HPV vaccination while an investigation into the safety of the vaccine was conducted. Such a safety study was carried out. Eight long years have passed since the recommendation was suspended, and during those eight years, almost no one was vaccinated, leaving large numbers of Japanese girls and women at future risk of HPV-driven cancers and cancer deaths

Safety and Efficacy of HPV Vaccination

Future Risk Caused by the Governmental Recommendation for HPV Vaccination

Women Who Missed Their Opportunity of HPV Vaccination

The Real Harm Caused by Vaccine Hesitancy

Findings

Conclusions