Streamlining the WHO cervical cancer elimination goal.

Abstract

Cervical cancer elimination is defined by WHO as reducing and maintaining the incidence of cervical cancer to less than four in 100 000 women. 1 Brisson M Kim JJ Canfell K et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020; 395: 575-590 Summary Full Text Full Text PDF PubMed Scopus (185) Google Scholar , 2 WHONew recommendations for screening and treatment to prevent cervical cancer. https://www.who.int/news/item/06-07-2021-new-recommendations-for-screening-and-treatment-to-prevent-cervical-cancerDate: July 6, 2021 Date accessed: September 29, 2021 Google Scholar Although this rate was reached in Finland in 1990–95 with an organised annual cytology screening system, it could not be maintained. 3 Harper DM Nieminen P Paavonen J Lehtinen M Cervical cancer incidence can increase despite HPV vaccination. Lancet Infect Dis. 2010; 10: 594-595 Summary Full Text Full Text PDF PubMed Scopus (31) Google Scholar Science and technology has evolved substantially from a test relying on cellular morphology to a precision medicine approach, with human papillomavirus (HPV) vaccination targeted to the most aggressive HPV types and primary HPV testing with biomarker triage. An understanding of which vaccine and how many doses to administer, as well as which primary HPV test and biomarkers to use for triage, are the remaining crucial questions, especially for communities with few resources. Recent evidence has produced clinical management risk thresholds for cervical intraepithelial neoplasia grade 3 or worse (CIN3+), which call for immediate treatment above the highest threshold and lesser thresholds for reassurance and extended surveillance. 4 Stanczuk GA Baxter GJ Currie H et al. Defining optimal triage strategies for hrhpv screen-positive women-an evaluation of HPV 16/18 genotyping, cytology, and p16/Ki-67 cytoimmunochemistry. Cancer Epidemiol Biomarkers Prev. 2017; 26: 1629-1635 Crossref PubMed Scopus (25) Google Scholar , 5 Egemen D Cheung LC Chen X et al. Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines. J Low Genit Tract Dis. 2020; 24: 132-143 Crossref PubMed Scopus (48) Google Scholar The risk-based framework allows new technology to evolve within a standardised clinical guideline for management, bringing more precision, and thus efficiency, to global cervical cancer prevention. Vaccine efficacy against persistent human papillomavirus (HPV) 16/18 infection at 10 years after one, two, and three doses of quadrivalent HPV vaccine in girls in India: a multicentre, prospective, cohort studyA single dose of HPV vaccine provides similar protection against persistent infection from HPV 16 and 18, the genotypes responsible for nearly 70% of cervical cancers, to that provided by two or three doses. Full-Text PDF Open AccessCorrection to Lancet Oncol 2021; 22: 1484–85Harper DM, Rozek LS. Streamlining the WHO cervical cancer elimination goal. Lancet Oncol 2021; 22: 1484–85—The sixth sentence of the second paragraph of this Comment should read: “At a median follow-up of 9·0 years (IQR 8·2–9·6) after the single quadrivalent HPV vaccination, 47 women remained in the observation cohort from the original 2135 women who were assessed.” This correction has been made to the online version as of Nov 29, 2021. Full-Text PDF