Every two minutes worldwide, a cancer caused by the human papillomavirus (HPV) claims another human life.
HPVs are a large family of viruses that cause everything from warts and other benign skin lesions to cancers. A subset of this family includes the “oncogenic” or cancer-causing strains of the virus. It is estimated that >99% of cervical cancers are caused by HPV infection, as well as a large percentage of cancers of the vagina, vulva, penis, anus, and oropharynx (throat). HPVs are highly prevalent: the Centers for Disease Control estimates that 80 million Americans are infected with some type of HPV, with 14 million new infections each year. Most of these infections are not caused by oncogenic strains and most will clear on their own without consequence; however, data from the American Cancer Society (ACS) predict about 13,000 new cases of cervical cancer in American women and about one-third of these will die from their disease.
The ACS is working to change these statistics. Josh Kellems, Health Systems Manager for the ACS North Central Region reports “The ACS is embarking on a nationwide campaign to create the first generation free from HPV cancers. The HPV vaccine delivers on a dream many have held for decades: a cancer prevention vaccine. Together, we can help prevent six types of cancer with the HPV vaccine.” A particular focus in Indiana is to increase the HPV vaccination rates for preteens, as Indiana currently ranks 35th out of 50 states nationally for female HPV immunization and 43rd out of 50 for males. In addition to narrowing the gender disparity gap, another statewide focus is to reduce geographic disparities in HPV vaccination. The poor rates of HPV vaccination in rural areas are not simply explained by lack of access to medical care, as Tdap (tetanus, diptheria, pertussis) vaccination rates are among the best in the nation (2nd of 50).
Worldwide, the statistics are even more dire. The World Health Organization (WHO) estimates that 570,000 new cases of cervical cancer were diagnosed worldwide in 2018, 85% of which were in low- and middle-income countries (LMIC). Of the >300,000 deaths worldwide attributed yearly to cervical cancer, 90% occur in LMIC. Accurate reporting on the incidence of other HPV-associated cancers in LMIC is more difficult to access. With regard to cervical cancer, lack of access to screening programs and HPV vaccines in low resource settings is largely responsible for the high mortality rate. In parts of sub-Saharan Africa, for example, cervical cancer is the leading cause of cancer death in women.
The currently available HPV vaccine Gardisil 9 is 97% effective against nine oncogenic HPV strains that cause the vast majority of HPV-associated cancers. In the United States, the vaccine is available for both female and male children beginning at age 9 and new regulations from the Food and Drug Administration in 2018 have approved the use of Gardisil 9 in women and men up to age 45. The data from Australia, where free school-based HPV vaccination for girls was introduced in 2007, with boys added in 2013, are amazing. Because of high levels of HPV vaccine uptake, Australia is on track to classify cervical cancer as a “rare” cancer (defined as 6 cases per 100,000) by 2022 and to be the first country in the world to effectively eliminate cervical cancer by 2028 (defined as four or fewer cases per 100,000 per year)!
Based on the overwhelming success of the HPV prevention program in Australia, the WHO has called for coordinated global efforts to eliminate cervical cancer through enhanced vaccine coverage and screening. In the absence of intervention, epidemiologic models predict 600,000 new cases of cervical cancer in 2020 and up to 1.3 million by 2069. In contrast, predictions show that the implementation of high vaccine and screening coverage could effectively eliminate cervical cancer worldwide by the end of the century. Take just two minutes to imagine the impact of access to HPV vaccination on the wellbeing of families worldwide.
For more information on:
HPV control in Indiana: https://www.in.gov/isdh/files/Indiana%20Cervical%20Cancer%20Strategic%20Plan.pdf
ACS recommendations for HPV vaccination:
WHO position paper on HPV vaccines:
https://www.sciencedirect.com/science/article/pii/S0264410X17307284