scholarly journals Modeling the impact of screening policy and screening compliance on incidence and mortality of cervical cancer in the post-HPV vaccination era

2012 ◽  
Vol 34 (4) ◽  
pp. 539-547 ◽  
Author(s):  
B. F. de Blasio ◽  
A. R. Neilson ◽  
M. Klemp ◽  
F. E. Skjeldestad
Vaccines ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 61 ◽  
Author(s):  
Eleanor Black ◽  
Robyn Richmond

Cervical cancer is a critical public health issue in sub-Saharan Africa (SSA), where it is the second leading cause of cancer among women and the leading cause of female cancer deaths. Incidence and mortality rates are substantially higher than in high-income countries with population-based screening programs, yet implementing screening programs in SSA has so far proven to be challenging due to financial, logistical, and sociocultural factors. Human Papillomavirus (HPV) vaccination is an effective approach for primary prevention of cervical cancer and presents an opportunity to reduce the burden from cervical cancer in SSA. With a number of SSA countries now eligible for Global Alliance for Vaccines and Immunization (GAVI) support for vaccine introduction, it is timely to consider the factors that impede and facilitate implementation of vaccine programs in SSA. This article describes epidemiological features of cervical cancer in SSA and the current status of HPV vaccine implementation in SSA countries. Rwanda’s experience of achieving high vaccination coverage in their national HPV immunization program is used as a case study to explore effective approaches to the design and implementation of HPV vaccination programs in SSA. Key factors in Rwanda’s successful implementation included government ownership and support for the program, school-based delivery, social mobilization, and strategies for reaching out-of-school girls. These findings might usefully be applied to other SSA countries planning for HPV vaccination.


2017 ◽  
Vol 11 (11) ◽  
pp. 819-825 ◽  
Author(s):  
Fatimah Saeed Alhamlan ◽  
Mohammed N A AlAhdal ◽  
Ali S Al-Zahrani ◽  
Shaihana A Almatrrouk

Cervical cancer is the fourth most common cancer affecting women, with worldwide annual incidence and mortality rates of 528,000 and 266,000, respectively, according to the World Health Organization. It is well established that cervical cancer is predominantly caused by a persistent human papillomavirus (HPV) infection of cervical cells. Increasing numbers of studies have investigated HPV and cervical cancer, contributing greatly to the global knowledge and unraveling some of the critical questions regarding HPV transmission, infection, and prevention. However, despite these studies, our knowledge is far from complete and much remains to be discovered. Although molecular detection and HPV prophylactic approaches have greatly advanced in recent years, approximately 85% of the global burden of mortality from cervical cancer still occurs in developing countries. Clinical and molecular epidemiological studies have demonstrated a need for developing countries in general to adopt cervical screening and vaccination programs. However, studies examining cervical cancer screening modalities and HPV prevalence as well as whether HPV vaccination programs should be implemented are lacking at the national level in some developing countries. Therefore, this review describes the current status of HPV in developing countries, presenting some of the existing challenges in implementing cervical screening and HPV vaccination programs.


Author(s):  
Eleanor Black ◽  
Robyn Richmond

In sub-Saharan Africa (SSA), cervical cancer is a critical public health issue; it is the second leading cause of cancer among women and the leading cause of female cancer deaths. Incidence and mortality rates are substantially higher than in high-income countries with population-based screening programs, yet implementing screening programs in SSA has so far proven to be challenging due to financial, logistical and sociocultural factors. Human Papillomavirus (HPV) vaccination is an effective approach for primary prevention of cervical cancer and presents an opportunity to reduce the burden from cervical cancer in SSA. With a number of SSA countries now eligible for GAVI support for vaccine introduction, it is timely to consider the factors that impede and facilitate implementation of vaccine programs in SSA. This article reviews the epidemiological and clinical features of cervical cancer in SSA and describes the current status of HPV vaccine implementation in SSA countries. The review considers the challenges that will need to be addressed, and effective approaches to the design and implementation of HPV vaccination programs, using Rwanda as a case study. The review aims to provide suggestions and guidance to those involved in the development and implementation of HPV vaccination programs in SSA.


2021 ◽  
Author(s):  
Phuong Lien Tran ◽  
Emmanuel Chirpaz ◽  
Malik Boukerrou ◽  
Antoine Bertolotti

BACKGROUND In Reunion Island, incidence and mortality for uterine cervical cancer is high, yet coverage rate for HPV vaccination is low. OBJECTIVE The main objective of the study is to evaluate, the impact of a health promotion program, promoting HPV vaccination, on the proportion of middle school girls who complete the full HPV vaccination schedule (2 or 3 doses) by the end of school year. METHODS This study is a cluster controlled intervention study using a superiority design. A combined health promotion program will be offered, containing: information to students and parents, training of general practitioners and free school-based vaccination (in a "health bus"). Children who will benefit from this program will constitute the intervention group, and will be compared to children from another middle school who will not benefit from any program, constituting the control group. RESULTS Our hypotheses were as follow : Clear and appropriate information for the target population as well as for their parents, will improve their knowledge about HPV vaccination, and thus increase their adherence to this vaccination ; combining information with vaccination in the school setting will reduce any material obstacles that may prevent the vaccination process; raising awareness among general practitioners will enable them to better understand the benefits and risks of HPV vaccination, and thus encourage families, who naturally trust them, to adhere to the program. CONCLUSIONS Final implication would be an extension of this program in all middle schools of the Island and thus increase HPV vaccination coverage. CLINICALTRIAL ClinicalTrials.gov ID: NCT04459221


2018 ◽  
Vol 25 (1) ◽  
pp. 107327481879930 ◽  
Author(s):  
Li Yuanyue ◽  
Zulqarnain Baloch ◽  
Li Shanshan ◽  
Nafeesa Yasmeen ◽  
Wu Xiaomei ◽  
...  

Cervical cancer (CC) has a high incidence and mortality and is accompanied by lack of organized CC screening programs, lack of health-care facilities, and a lack of human papillomavirus (HPV) vaccination among female population in the world, particularly China. We recruited 487 females who visited the outpatient department of the First People’s Hospital of Yunnan Province from November 2015 to January 2016 to complete a standardized-designed questionnaire. We found that only 39.6% of the females knew about the role of HPVs in the development of cervical cancer. Moreover, none of the females knew that HPV could cause penile carcinomas, perianal carcinomas, and head and neck carcinomas. The majority of the participants acquired information about cervical cancer, HPV, and the HPV vaccine from medical workers. Only 15.6% of the recruited females had heard about the HPV vaccine. The overall HPV vaccine acceptance rate was higher (91.2%) if the vaccine was available free of cost. In this study, we found high acceptability of the HPV vaccine in Chinese women and high awareness about cervical cancer. However, very low levels of knowledge about HPVs and their role in cancer development among the recruited women is alarming. Therefore, it is very important to initiate educational programs to raise awareness and knowledge about cervical cancer, HPV, and the HPV vaccine in this region.


2020 ◽  
Vol 66 (4) ◽  
pp. 325-335
Author(s):  
David Zaridze ◽  
Dmitriy Maksimovich ◽  
Ivan Stilidi

The incidence of cervical cancer in Russia is one of the highest in Europe. At the same time, in European countries, the incidence of other HPV-associated tumors is as low as in Russia. The incidence of cervical cancer is declining in most countries of the world. Unfortunately, in our country, a decrease in the incidence and mortality from cervical cancer before the early 1990s was replaced by an increase in these rates. This trend will continue and reach fairly high numbers in 2030. The increase and subsequent decrease in the incidence and mortality of cervical cancer, which has been observed in developed countries for several decades, is largely the result of population cytological screening with coverage of 70-80% of the female population of the corresponding age. In our country cytological testing organized in the polyclinics, which covered a significant proportion of working women and which, as you know, has been introduced into healthcare practice since 1976, has led only to a temporary decrease in the incidence of cervical cancer. Unfortunately, in the late 1980s, this program ceased to exist and, consequently, a decrease in the incidence of cervical cancer was replaced by its growth. So called dispanserisation, which is presently in place, which includes cytological screening of cervical cancer, has not yet led to the expected results. Despite the fact that the goal of our article is not to evaluate the effectiveness of various screening methods, we consider it necessary to note that screening with HPV testing, which according to randomized trials, is much more effective than cytological examination is widely used in most countries, in combination with HPV vaccination. Prevention of cervical cancer includes: a) mandatory vaccination against HPV in adolescence (11-13 years); b) screening based on HPV testing.


2012 ◽  
Vol 13 (2S) ◽  
pp. 3-15
Author(s):  
Paolo Bonanni ◽  
Donatella Panatto ◽  
Bruna Dirodi ◽  
Sara Boccalini ◽  
Roberto Gasparini

Introduction: by means of the decisions on whether to introduce the HPV vaccination, Public Health has already established the importance of associating the vaccination strategy to the policy of secondary prevention. The screening + vaccination strategy is more effective than the two methods taken individually. In support of this combined strategy and in order to make available per each region concrete elements for their regional planning, an assessment has been made, which also takes into account the effect of cross-protection regarding high-risk strains not contained in both vaccines, bivalent and quadrivalent, and more frequently responsible for pre-cancerous lesions and cervical cancer (CCU). This analysis evaluates the costs and benefits of screening + vaccination strategy in a 12-year-old female cohort. Furthermore, the paper provides results that may be useful to assess the opportunity to extend the vaccination to a second cohort of 24-25-year-old women. The analysis is preceded by a brief summary of CCU epidemiology available data, public health policies that give precise guidelines for vaccination strategies and analytical tools suitable to support public policy makers to efficiently allocate resources. Methods: two different models were used for two regional analyses.The vaccines may have different sustained- and cross-protection levels against non-vaccine oncogenic HPV-types. In the first analysis, a prevalence-based model estimated the potential net difference in HPV-related lesions (abnormal pap smear, cervical intraepithelial neoplasia (CIN), cervical cancer (CC) and genital warts (GW)) and associated costs generated by the two vaccines. Vaccine efficacy rates were based on published data for each vaccine. Lifetime vaccine efficacy was assumed. Results are reported over one year after reaching a steady state. Incidence and treatment costs were obtained from Italian and European sources. We also performed a cost-effectiveness analysis with a Markov model for each Italian region, previously described and successfully adapted to the national scenario. The analysis compares the HPV vaccination of a single cohort (12-year-old females) with a multiple cohort (12- + 25-year-old girls). Resource use was based on a standard therapeutic path applied to all regions. However we quantified the impact of the so-called “decentralization progress” by collecting regional data on: pap test coverage, tariffs for treatments, and cost of the vaccination course. Results: the results are set out in 21 regional reports. Conclusions: in the Italian scenario, characterized by decentralization and local autonomy, a further level of detail is essential in order to describe the specific local settings and implications of a new health intervention. The results show that the vaccination on a multiple cohort is more effective than a single cohort. Indeed, a major number of pre-cancerous lesions, cases of cancer, and related deaths are avoided. In a period of sharp decline in the health budget, investment in prevention seems to be the most reasonable choice in view of avoiding in the medium term pre-cancerous and cancerous lesions generating a significant expense. Our analysis places the extent of HPV vaccination among the measures that the regional decision-makers should put in place to maximize the efficiency of scarce resource.


Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 310 ◽  
Author(s):  
Julia M. L. Brotherton ◽  
John M. Kaldor ◽  
Suzanne M. Garland

This paper describes a possible multifaceted approach to human papillomavirus (HPV) related surveillance in Australia following implementation of a national HPV vaccination program. We describe eight main components: monitoring of vaccine coverage, vaccine safety, type-specific HPV infection surveillance, cervical cytology (Pap screening) coverage and screen detected lesion prevalence, cervical cancer incidence and mortality, genital wart incidence, incidence of recurrent respiratory papillomatosis, and knowledge, attitudes and beliefs about HPV and HPV vaccination. Australia is well placed to monitor the impact of its HPV vaccination program as well as to measure vaccine effectiveness with existing HPV vaccines, cervical screening and cancer registries.


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