Potential for cervical cancer incidence and death resulting from Japan’s current policy of prolonged suspension of its governmental recommendation of the HPV vaccine

Abstract In 2013, recurrent reports of diverse symptoms occurring in girls after receiving HPV vaccination appeared in Japanese media. The Ministry of Health, Labor and Welfare quickly responded by announcing a temporary suspension of its recommendation for the vaccine. The HPV vaccination rate soon fell to almost zero. In the present study, we calculated the potential future numbers of cervical cancer incidence and death that will be increased by this policy decision. We have assumed that the number of yearly vaccinations is evenly distributed across a daily basis. Future incidence and death increased in females born in FY2000 are estimated to be 3651 and 904, respectively, 4566 and 1130 for those born in FY2001, 4645 and 1150 for those born in FY2002, and 4657 and 1153 for those born in FY2003. In FY2020, the large increase of risks to females born in FY2004 amounts to 12.0 females per day who will now be at a higher risk for acquiring of cervical cancer in their future, and 3.0 females per day newly at risk for future death from that disease in its progressive form. No one should be able to accept this situation. We sincerely ask the government to resume its recommendation for the vaccine as soon as possible.

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Cervical cancer incidence can increase despite HPV vaccination

The Lancet Infectious Diseases ◽

10.1016/s1473-3099(10)70182-1 ◽

2010 ◽

Vol 10 (9) ◽

pp. 594-595 ◽

Cited By ~ 23

Author(s):

Diane M Harper ◽

Pekka Nieminen ◽

Jorma Paavonen ◽

Matti Lehtinen

Keyword(s):

Cervical Cancer ◽

Cancer Incidence ◽

Hpv Vaccination ◽

Cervical Cancer Incidence

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Cost-effectiveness of HPV vaccination in the context of high cervical cancer incidence and low screening coverage

Vaccine ◽

10.1016/j.vaccine.2017.08.083 ◽

2017 ◽

Vol 35 (46) ◽

pp. 6329-6335 ◽

Cited By ~ 2

Author(s):

Triin Võrno ◽

Katrin Lutsar ◽

Anneli Uusküla ◽

Lee Padrik ◽

Terje Raud ◽

...

Keyword(s):

Cervical Cancer ◽

Cost Effectiveness ◽

Cancer Incidence ◽

Hpv Vaccination ◽

Cervical Cancer Incidence ◽

Screening Coverage ◽

High Cervical

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Cost-Effectiveness of HPV-Vaccination in Medium or Low Income Countries with High Cervical Cancer Incidence – A Systematic Review

Journal of Vaccines & Vaccination ◽

10.4172/2157-7560.1000172 ◽

2013 ◽

Vol 04 (01) ◽

Cited By ~ 2

Author(s):

Natunen K Lehtinen TA

Keyword(s):

Systematic Review ◽

Cervical Cancer ◽

Cost Effectiveness ◽

Cancer Incidence ◽

Low Income ◽

Hpv Vaccination ◽

Low Income Countries ◽

Cervical Cancer Incidence ◽

High Cervical

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Evaluating Clinical and Cost Impacts of Achieving 90% HPV Vaccination Rate Against Cervical Cancer in Canada Using the OncoSim Cancer Simulation Model

Journal of Global Oncology ◽

10.1200/jgo.18.27600 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 21s-21s

Author(s):

N. Fitzgerald ◽

S. Hussain ◽

S. Memon ◽

C. Gauvreau ◽

W. Flanagan ◽

...

Keyword(s):

Cervical Cancer ◽

Health System ◽

Hpv Vaccine ◽

Average Rate ◽

Hpv Vaccination ◽

Vaccination Rate ◽

Treatment Costs ◽

Microsimulation Model ◽

Statistics Canada ◽

Incident Cases

Background: Cervical cancer can be largely prevented through vaccination against the human papillomavirus (HPV). In Canada, HPV vaccination of school-aged girls started in 2008 and has reached an average rate of 67% across the country. However, this rate is below a current national target of 90%. Aim: We project the difference in lifetime clinical outcomes and health system costs of achieving a 90% HPV vaccination rate versus a 67% rate for girls vaccinated in 2015 using the OncoSim-Cervical model. Methods: The OncoSim-Cervical model (version 2.5) is a microsimulation model led by the Canadian Partnership Against Cancer, with model development by Statistics Canada, to evaluate the impacts of cervical cancer interventions in Canada. It has two parts, the first, the HPV Microsimulation Model, simulates the transmission of HPV between males and females including possible modulation by vaccination and herd immunity, and provides projections of HPV infection and prevalence for input to the cervical cancer natural history component in the second part. We simulated two cohorts of 5-10 year old girls in 2015; one receiving HPV vaccination at the rate of 67% and another at 90%. Their relative lifetime cervical cancer outcomes and costs were compared. Assumptions included: 100% efficacy of the HPV vaccine; triennial cytology screening between ages 21 and 65; 90% screening recruitment of age-eligible women with 80% rescreening; and a $500 cost for a 3-dose quadrivalent HPV vaccine regimen. Projected costs were undiscounted and are in 2016 CAD. Results: Compared with the 67%-vaccinated cohort, in the 90%-vaccinated cohort there was a lifetime reduction of 23% in cervical cancer incident cases and 21% in cervical cancer deaths. Lifetime cancer treatment costs decreased by $26 million (23%), and wart treatment costs and precervical cancer costs decreased by $3.2 million (15%) and $45 million (16%) respectively. Lifetime screening costs decreased by $47 million (2%). Conclusion: Achieving a nationally-set target of 90% HPV vaccination in Canadian girls would not only save more lives but would free up funds that could be redirected to other health system needs. Planners could aim for relatively high nation-wide rates of HPV vaccination coverage to enhance their cervical cancer control strategy.

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Indonesia's Readiness to Implement the HPV Vaccine Mandatory for School Age

Health Science Journal of Indonesia ◽

10.22435/hsji.v9i2.910 ◽

2018 ◽

Vol 9 (2) ◽

pp. 107-118

Author(s):

Dumilah Ayuningtyas ◽

Ni Nyoman Dwi Sutrisnawati

Keyword(s):

Systematic Review ◽

Cervical Cancer ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Pilot Project ◽

School Age ◽

National Immunization Program ◽

Immunization Program ◽

National Immunization ◽

The Government

Latar Belakang: Menurut WHO, dua dari 10.000 wanita di Indonesia hidup dengan kanker serviks dan diperkirakan 26 wanita meninggal setiap hari akibat kanker serviks. Berdasarkan kondisi ini, pemerintah Indonesia berencana menambahkan vaksin HPV ke dalam program imunisasi nasional. Tujuan penelitian adalah untuk menilai kemungkinan kesiapan Indonesia untuk menerapkan vaksin HPV wajib untuk usia sekolah dan faktor-faktor yang dapat mempengaruhinya. Metode: Metode yang digunakan adalah systematic review. Melalui artikel terkait vaksin HPV yang terbit di jurnal terakreditasi dan scopus-indeks selama 10 tahun terakhir dengan kata kunci "Implementasi untuk Imunisasi HPV", ditemukan sebanyak 17.000 hasil pencarian. Setelah itu, penilaian kritis pada artikel yang dipilih dilakukan dengan menggunakan metode PRISMA. Hasil: Ditemukan bahwa kesadaran masyarakat, terutama orang tua, tentang vaksin HPV masih kurang, namun penerimaan mereka terhadap vaksin ini cukup positif. Ada beberapa faktor lain yang menjadi keberatan mereka terhadap vaksin, seperti harga tinggi, ketakutan akan efek samping, seksualitas, gender, dan sistem perawatan kesehatan. Saat ini di Indonesia vaksin HPV harus dibeli atas inisiatif mereka sendiri dan bukan merupakan program wajib dari pemerintah pusat dan juga tidak diberikan secara gratis melalui program JKN. Namun demikian, Kementerian Kesehatan telah memulai proyek percontohan untuk menyediakan vaksinasi HPV gratis di beberapa daerah dalam Program Bulan Imunisasi untuk Usia Sekolah menggunakan kombinasi sumber daya pusat dan daerah. Kesimpulan: Telah ada peraturan dan pedoman teknis untuk pelaksanaan proyek percontohan vaksinasi HPV gratis, namun masih perlu penyesuaian dan dukungan dari Pemerintah jika akan dilaksanakan secara nasional dan disesuaikan dengan kondisi di daerah dengan fasilitas dan akses terbatas. Dibutuhkan peran pemerintah dalam memberikan informasi yang baik tentang vaksin HPV bagi masyarakat. Keyword: Vaksin HPV, Kesiapan Implementasi, Program Imunisasi Nasional Abstract Background: According to WHO, two out of 10,000 women in Indonesia live with cervical cancer and an estimated 26 women die each day from cervical cancer. Indonesian government is planning to add the HPV vaccine into the national immunization program. The objective is to assess the possibility of Indonesia's readiness to implement the HPV vaccine mandatory for school age and factors that may affect it. Methods: The method was a systematic review through articles related to HPV vaccine which have been published in accredited and scopus-indexed journals for the last 10 years. With keywords "Implementation for HPV Immunization", founded 17,000 search results. Afterwards, a critical appraisal on the selected articles is conducted using PRISMA method. Results: It is found that the awareness of community, especially parents, about HPV vaccine is still lacking, but their acceptance of this vaccine is quite positive. There are other factors into their objection to vaccines, such as the high price, fear of the side effects, sexuality, gender, and healthcare systems. Currently in Indonesia HPV vaccine must be purchased on their own initiative and is not a mandatory program of the central government. Neither has it been given free of charge through JKN program. Nevertheless, The Ministry of Health has begun a pilot project to provide free HPV vaccination in some areas within Immunization Month for School Age program using a combination of central and regional resources. Conclusion: Although there have been regulations and technical guidelines for the implementation of the pilot project of free HPV vaccination, it still needs adjustment and support from the Government if it will be implemented nationally and adapted to conditions in areas with limited facilities and access. The role of the government is needed in providing good knowledge about the HPV vaccine for the community. Keyword: HPV Vaccine, Implementation Readiness, National Immunization Program

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Impact of screening on cervical cancer incidence in England: a time trend analysis

BMJ Open ◽

10.1136/bmjopen-2018-026292 ◽

2019 ◽

Vol 9 (1) ◽

pp. e026292 ◽

Cited By ~ 3

Author(s):

Francesca Pesola ◽

Peter Sasieni

Keyword(s):

Cervical Cancer ◽

Trend Analysis ◽

Cancer Incidence ◽

Cervical Screening ◽

Hpv Vaccination ◽

Cervical Cancer Incidence ◽

Incidence Data ◽

Cancer Registry Data ◽

Current Scenario ◽

The Impact

ObjectivesTo better model underlying trends in cervical cancer incidence so as to model past trends, to estimate the impact of cervical screening on cervical cancer rates at different ages and to obtain a counterfactual baseline under a no-screening scenario.DesignTrend analysis of cancer registry data recorded between 1971 and 2013.SettingEngland.Participants132 493 women aged 20–84 with a diagnosis of cervical cancer.Outcome measureCervical cancer incidence data were modelled using a modified age period cohort model able to capture both increased exposure to human papillomavirus (HPV) as well as changes in the age of exposure to HPV in young cohorts. Observed rates were compared with counterfactual baseline rates under a no-screening scenario to estimate the protective effect of screening.ResultsRates of cervical cancer incidence have been decreasing since the introduction of screening but are projected to increase in the future under the current scenario. Between 1988 and 2013, it was estimated that screening had prevented approximately 65 000 cancers. Moreover, in 2013, the age-standardised rate (ASR) estimated under the no-screening scenario (37.9, 95% CI 37.4 to 38.3) was threefold higher among women aged 20–84 than the observed ASR (12.8, 95% CI 12.3 to 13.3). We estimate that the age of first HPV exposure has decreased by about 1 year every decade since the early 1970s (women born in 1955 onwards).ConclusionsOur results corroborated the importance of screening in preventing cervical cancer and indicated future rates are dependent on age at HPV exposure. Estimated future rates can be used for healthcare planning while the counterfactual baseline to quantify the impact of HPV vaccination in microsimulations.

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The last strategy for re-dissemination of HPV vaccination in Japan while still under the suspension of the governmental recommendation

Scientific Reports ◽

10.1038/s41598-020-73120-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Yutaka Ueda ◽

Asami Yagi ◽

Hazuki Abe ◽

Satoshi Nakagawa ◽

Ryoko Minekawa ◽

...

Keyword(s):

Cervical Cancer ◽

Local Government ◽

Hpv Vaccine ◽

Local Governments ◽

Hpv Vaccination ◽

Vaccination Rate ◽

National Government ◽

Fiscal Year ◽

Academic Organizations ◽

Media Reports

Abstract In Japan, the governmental recommnendation of HPV vaccine has been suspended since June 2013, due to media reports of alleged adverse vaccination events. Although evidence of effectiveness and safety of the HPV vaccine has been universally demonstrated, and the medical and academic organizations across Japan have requested the resumption of the government’s recommendation, the Japanese government has not changed their official stance towards the HPV vaccine. Under the current suspension of the national government’s recommendation, one local government Isumi City started sending a leaflet containing information of cervical cancer and HPV vaccine, but not recommendation for the vaccine, to the tagted girls born in the fiscal year (FY) 2003. The cumulative vaccination rate of them reached 10.07% (14/139), which was significantly higher than that (0.00%) for girls born in FY 2002 who did not receive such a leaflet (p < 0.001). We sincerely ask the national government to change their stance towards the HPV vaccine. We also strongly suggest that, in the meantime, local governments immediately begin to provide an appropriate information of cervical cancer and HPV vaccine to the targeted girls and their parents in a way similar to what Isumi City has now shown to be effective.

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