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Showing content from https://pubmed.ncbi.nlm.nih.gov/32007142/ below:

Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries

. 2020 Feb 22;395(10224):591-603. doi: 10.1016/S0140-6736(20)30157-4. Epub 2020 Jan 30. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries Jane J Kim², Marc Brisson³, Adam Keane⁴, Kate T Simms⁴, Michael Caruana⁴, Emily A Burger⁵, Dave Martin⁶, Diep T N Nguyen⁴, Élodie Bénard⁶, Stephen Sy², Catherine Regan², Mélanie Drolet⁶, Guillaume Gingras⁶, Jean-Francois Laprise⁶, Julie Torode⁷, Megan A Smith⁴, Elena Fidarova⁸, Dario Trapani⁸, Freddie Bray⁹, Andre Ilbawi⁸, Nathalie Broutet¹⁰, Raymond Hutubessy¹¹

Affiliations

¹ Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia. Electronic address: karen.canfell@nswcc.org.au.
² Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA.
³ Centre de recherche du CHU de Québec - Université Laval, Québec, QC, Canada; Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, UK.
⁴ Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
⁵ Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
⁶ Centre de recherche du CHU de Québec - Université Laval, Québec, QC, Canada.
⁷ Union for International Cancer Control, Geneva, Switzerland.
⁸ Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland.
⁹ Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
¹⁰ Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
¹¹ Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.

PMID: 32007142
PMCID: PMC7043006
DOI: 10.1016/S0140-6736(20)30157-4

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Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries

Karen Canfell et al. Lancet. 2020.

. 2020 Feb 22;395(10224):591-603. doi: 10.1016/S0140-6736(20)30157-4. Epub 2020 Jan 30. Authors Karen Canfell¹, Jane J Kim², Marc Brisson³, Adam Keane⁴, Kate T Simms⁴, Michael Caruana⁴, Emily A Burger⁵, Dave Martin⁶, Diep T N Nguyen⁴, Élodie Bénard⁶, Stephen Sy², Catherine Regan², Mélanie Drolet⁶, Guillaume Gingras⁶, Jean-Francois Laprise⁶, Julie Torode⁷, Megan A Smith⁴, Elena Fidarova⁸, Dario Trapani⁸, Freddie Bray⁹, Andre Ilbawi⁸, Nathalie Broutet¹⁰, Raymond Hutubessy¹¹ Affiliations

¹ Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia. Electronic address: karen.canfell@nswcc.org.au.
² Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA.
³ Centre de recherche du CHU de Québec - Université Laval, Québec, QC, Canada; Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, UK.
⁴ Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
⁵ Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
⁶ Centre de recherche du CHU de Québec - Université Laval, Québec, QC, Canada.
⁷ Union for International Cancer Control, Geneva, Switzerland.
⁸ Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland.
⁹ Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
¹⁰ Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
¹¹ Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.

PMID: 32007142
PMCID: PMC7043006
DOI: 10.1016/S0140-6736(20)30157-4

Item in Clipboard

Abstract

Background: WHO is developing a global strategy towards eliminating cervical cancer as a public health problem, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of human papillomavirus (HPV) vaccination to 90%, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%. We assessed the impact of achieving the 90-70-90 triple-intervention targets on cervical cancer mortality and deaths averted over the next century. We also assessed the potential for the elimination initiative to support target 3.4 of the UN Sustainable Development Goals (SDGs)-a one-third reduction in premature mortality from non-communicable diseases by 2030.

Methods: The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC) involves three independent, dynamic models of HPV infection, cervical carcinogenesis, screening, and precancer and invasive cancer treatment. Reductions in age-standardised rates of cervical cancer mortality in 78 low-income and lower-middle-income countries (LMICs) were estimated for three core scenarios: girls-only vaccination at age 9 years with catch-up for girls aged 10-14 years; girls-only vaccination plus once-lifetime screening and cancer treatment scale-up; and girls-only vaccination plus twice-lifetime screening and cancer treatment scale-up. Vaccination was assumed to provide 100% lifetime protection against infections with HPV types 16, 18, 31, 33, 45, 52, and 58, and to scale up to 90% coverage in 2020. Cervical screening involved HPV testing at age 35 years, or at ages 35 years and 45 years, with scale-up to 45% coverage by 2023, 70% by 2030, and 90% by 2045, and we assumed that 50% of women with invasive cervical cancer would receive appropriate surgery, radiotherapy, and chemotherapy by 2023, which would increase to 90% by 2030. We summarised results using the median (range) of model predictions.

Findings: In 2020, the estimated cervical cancer mortality rate across all 78 LMICs was 13·2 (range 12·9-14·1) per 100 000 women. Compared to the status quo, by 2030, vaccination alone would have minimal impact on cervical cancer mortality, leading to a 0·1% (0·1-0·5) reduction, but additionally scaling up twice-lifetime screening and cancer treatment would reduce mortality by 34·2% (23·3-37·8), averting 300 000 (300 000-400 000) deaths by 2030 (with similar results for once-lifetime screening). By 2070, scaling up vaccination alone would reduce mortality by 61·7% (61·4-66·1), averting 4·8 million (4·1-4·8) deaths. By 2070, additionally scaling up screening and cancer treatment would reduce mortality by 88·9% (84·0-89·3), averting 13·3 million (13·1-13·6) deaths (with once-lifetime screening), or by 92·3% (88·4-93·0), averting 14·6 million (14·1-14·6) deaths (with twice-lifetime screening). By 2120, vaccination alone would reduce mortality by 89·5% (86·6-89·9), averting 45·8 million (44·7-46·4) deaths. By 2120, additionally scaling up screening and cancer treatment would reduce mortality by 97·9% (95·0-98·0), averting 60·8 million (60·2-61·2) deaths (with once-lifetime screening), or by 98·6% (96·5-98·6), averting 62·6 million (62·1-62·8) deaths (with twice-lifetime screening). With the WHO triple-intervention strategy, over the next 10 years, about half (48% [45-55]) of deaths averted would be in sub-Saharan Africa and almost a third (32% [29-34]) would be in South Asia; over the next 100 years, almost 90% of deaths averted would be in these regions. For premature deaths (age 30-69 years), the WHO triple-intervention strategy would result in rate reductions of 33·9% (24·4-37·9) by 2030, 96·2% (94·3-96·8) by 2070, and 98·6% (96·9-98·8) by 2120.

Interpretation: These findings emphasise the importance of acting immediately on three fronts to scale up vaccination, screening, and treatment for pre-invasive and invasive cervical cancer. In the next 10 years, a one-third reduction in the rate of premature mortality from cervical cancer in LMICs is possible, contributing to the realisation of the 2030 UN SDGs. Over the next century, successful implementation of the WHO elimination strategy would reduce cervical cancer mortality by almost 99% and save more than 62 million women's lives.

Funding: WHO, UNDP, UN Population Fund, UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction, Germany Federal Ministry of Health, National Health and Medical Research Council Australia, Centre for Research Excellence in Cervical Cancer Control, Canadian Institute of Health Research, Compute Canada, and Fonds de recherche du Québec-Santé.

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Figures
Figure 1

Age-standardised cervical cancer mortality over…

Figure 1

Age-standardised cervical cancer mortality over time for all 78 LMICs The solid lines…

Figure 1

Age-standardised cervical cancer mortality over time for all 78 LMICs The solid lines represent the median outcome of the three models; the shading represents the range of model outputs. HPV=human papillomavirus. LMICs=low-income and lower-middle-income countries. S0=status quo (no scale-up of vaccination, screening or treatment). S1=female-only vaccination at 9 years with multi-age cohort catch-up to age 14 years in 2020. S2=female-only vaccination and once-lifetime HPV testing at age 35 years with cancer treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years with cancer treatment scale-up. Supplementary S4=female-only vaccination at 9 years with extended multi-age cohort catch-up to age 25 years in 2020. Supplementary S5=female and male vaccination at age 9 years with multi-age cohort catch-up to age 14 years in 2020. All scenarios assume the use of a broad-spectrum HPV vaccine with protection against seven oncogenic types.

Figure 2

Projected cervical cancer deaths across…

Figure 2

Projected cervical cancer deaths across all 78 low-income and lower-middle-income countries (A) Annual…

Figure 2

Projected cervical cancer deaths across all 78 low-income and lower-middle-income countries (A) Annual cervical cancer deaths. (B) Cumulative cervical cancer deaths averted. The solid lines in panel A represent the median of the three models and the shading represents the range of the model outputs. In panel B the column height represents the median of the three models and the error bars represent the range of the three models. HPV=human papillomavirus. S0=status quo (no scale-up of vaccination, screening, or treatment). S1=female-only vaccination at age 9 years with multi-age cohort catch-up to age 14 years in 2020. S2=female-only vaccination and once-lifetime HPV testing at age 35 years with cancer treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years with cancer treatment scale-up. Supplementary S4=female-only vaccination at age 9 years with extended multi-age cohort catch-up to age 25 years in 2020. Supplementary S5=female and male vaccination at age 9 years with multi-age cohort catch-up to age 14 years in 2020. All scenarios assume the use of a broad-spectrum HPV vaccine with protection against seven oncogenic types.

Figure 3

Age-standardised cervical cancer mortality over…

Figure 3

Age-standardised cervical cancer mortality over time for LMICs in each region The solid…

Figure 3

Age-standardised cervical cancer mortality over time for LMICs in each region The solid lines represent the median outcome of the three models; the shading represents the range of model outputs. HPV=human papillomavirus. LMICs=low-income and lower-middle-income countries. S0=status quo (no scale-up of vaccination, screening or treatment). S1=female-only vaccination at 9 years with multi-age cohort catch-up to age 14 years in 2020. S2=female-only vaccination and once-lifetime HPV testing at age 35 years with cancer treatment scale-up. S3=female-only vaccination and twice-lifetime HPV testing at age 35 years and 45 years with cancer treatment scale-up. Supplementary S4=female-only vaccination at 9 years with extended multi-age cohort catch-up to age 25 years in 2020. Supplementary S5=female and male vaccination at age 9 years with multi-age cohort catch-up to age 14 years in 2020. All scenarios assume the use of a broad-spectrum HPV vaccine with protection against seven oncogenic types.

Comment in

Cervical cancer elimination: are targets useful?
Tsu VD. Tsu VD. Lancet. 2020 Feb 22;395(10224):539-540. doi: 10.1016/S0140-6736(20)30219-1. Epub 2020 Jan 30. Lancet. 2020. PMID: 32007140 No abstract available.
Eliminating cervical cancer.
The Lancet. The Lancet. Lancet. 2020 Feb 1;395(10221):312. doi: 10.1016/S0140-6736(20)30247-6. Lancet. 2020. PMID: 32007146 No abstract available.