HPV Vaccination and Cervical Cancer Screening in Taiwan

Abstract

Background and context: Cervical cancer has been one of the most important cancers over the last 3 decades in Taiwan, and it still is among the top 10 cause of death for women. Aim: The aim of the policy was to achieving the following KPIs: HPV vaccine inoculation rate to 60%; 30-69 year Papanicolaou test screening rate ≥ 70%; and cervical cancer mortality dropped to 3.3/105 (baseline 1995 = 11/105). Strategy/Tactics: We provided annual Pap test for all women aged 30 years or more since 1995 and encourage women to screen at least every 3 years. We will introduce national HPV vaccination program for girls aged 13 years later this year. Program/Policy Process: We used a coordinated multichannel delivery system including clinical and community approaches that empower people to access services. The cost of treatment was covered by the universal health insurance. Our vaccination program started from whom are likely to have less access to screening later in life since 2011, and some cities/counties initiated their own vaccination program. Our national HPV vaccination aims to increase the inoculation rate to 60%. Outcomes: The standardized cervical cancer incidence rate decreased by 66%, from 25 per 100,000 in 1995 to 8.5 per 100,000 in 2014. The standardized mortality rate fell by 70% between 1995 and 2016, from 11 to 3.3 people per 100,000. In 2015, the total inoculation rate was about 38%. According to the Vaccine Adverse Effect Reporting System, the HPV vaccine is very safe. Among almost 820,000 doses inoculated from 2010 to 2016, the number of adverse effect was 2107 (0.25%). What was learned: The policy combined HPV vaccination and national Papanicolaou test screening strategies are successful. The implementation of the act, funding allocation, information system, health education to target population and medical staff as well as media advocacy, were keys to success.