Cervical cancer is a major problem worldwide and in India. HPV is the primary cause, with types 16 and 18 responsible for about 80% of cases globally. A large Swedish study found HPV vaccination reduced cervical cancer risk by 63% compared to unvaccinated women. WHO guidelines recommend girls-only HPV vaccination before age 9 along with twice-lifetime screening to accelerate global cervical cancer elimination between 2059 to 2102 and prevent an additional 12.1 million cases.

1. Dr. V. Lokesh
Director and Professor
Kidwai Memorial Institute of Oncology, Bangalore

2. Cervical Cancer
Worldwide - 4th most common cancer
 estimated ~ 604,127 new cases
 Deaths ~ 341,831
In India : 2nd leading
 ~ 123,907 new cervical cancer cases PA
Karnataka
 Female Cancer : 49630
 Cervical ~5206 PA

3. Incidence Rate

4. ETIOLOGY
HPV is a most common cause, but not the only cause.
Human Papilloma Virus (HPV): >95% of around world
& 92-96% in India.
14 different types are associated with causing of cancer cervix:
16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68
 Type 16/18 responsible for ~80% cancer cervix.
 Jayshree et al in 2010 showed 92.1% of Cervical cancer
patients in India had HPV, in other cities :
Delhi 91.7%; Bangalore 91.5%; Mumbai 89.1%; Vellore
95.8%; Kolkata 96.5%; Trivandrum 89.9%
 IARC India Fact sheet in 2023 have shown that
83.2% of cervical cancer was associated with HPV.

5. HPV 16 & 18 – Prevalence in Cytology
samples
 The HPV types 16 and 18 were consistently found in
about 70% of cervical cancer biopsies throughout the
world

6. Cervical Cancer Prevention
 The first HPV vaccine became available in 2006
 Comprehensive cervical cancer control includes
 primary prevention (vaccination against HPV),
 secondary prevention (screening and treatment of pre-
cancerous lesions),
 tertiary prevention (diagnosis and treatment of invasive
cervical cancer) and
 palliative care.

7. HPV vaccine & Cervical Cancer
Prevention : Swedish study -largest
 compare cervical cancer diagnoses among women who did and
did not receive an HPV vaccine
 between 2006 and 2017
 HPV vaccine against four HPV types: HPV 6, HPV 11, HPV 16,
and HPV 18
 study ages of 10 and 30.
 N= ~ 528,000 received at least one dose of the vaccine (80% <
17yrs), v/s 1.14 million had not been vaccinated.
 Result: Those diagnosed with cervical cancer
 Vaccinate: 19 v/s un-vaccinated 538
 63% reduced risk of being diagnosed with cervical cancer among
females who had been vaccinated compared with those who
hadn’t.
 The nearly 90% reduction in cervical cancer among women who
were vaccinated at a younger age makes sense

8.  study of nearly 1.7 million women, the vaccine’s
efficacy was particularly pronounced among girls
vaccinated before age 17
 HPV vaccines are used to prevent HPV infection and
therefore cervical cancer.[

9. Vaccinating : females & males
 between the ages of nine to thirteen
 is typically recommended,
 United States - CDC recommends 11- to 12-year-olds
receive two doses of HPV vaccine, administered 6 to 12
months apart.
 The vaccines require three doses for those ages 15 and
above

10. India
 HPV vaccination has been recommended by
the National Technical Advisory Group on
Immunization, but has not been implemented in India
as of 2018.

11. Current Scenario
HPV Vaccine Coverage
 LMICs 30%
 High income countries 85%
screened for cervical cancer
 LMICs 20%
 high-income countries 60%

12. vaccination coverage
 high-income countries –
 declines of 73–85% in vaccine-type HPV prevalence
 declines of 41–57% in high grade lesions (cervical
intraepithelial neoplasia, grade 2 or worse) among young
women, less than 10 years after implementation of HPV
vaccination
The effectiveness of population-based cervical cancer
screening:
 cytology-based screening: sharp declines in age-
standardized cervical cancer incidence in high-income
countries
 HPV based tests: Randomized controlled trials - highly
effective at detecting precancerous lesions than cytology
and are likely to be more effective at preventing cervical
cancer

13. WHO Global Strategy to Accelerate the
Elimination of Cervical Cancer as a
Public Health Problem mandate
mathematical modeling: global maps of cervical
cancer elimination over time :: change in the distribution of the
country-specific age-standardised cervical cancer incidence over
time

15.  Girls-only HPV
vaccination was
predicted to reduce
the median age-
standardised
cervical cancer
incidence in LMICs
from 19·8 (range
19·4–19·8) to 2·1 (2·0–
2·6) cases per 100000
women-years over
the next century
(89·4% [86·2–90·1]
reduction), and to
avert 61·0 million
(60·5–63·0) cases
during this period.
Adding twice-
lifetime

19. GUIDELINES
 The latest study conducted by WHO
Arms of study
Vacc--HPV types 16, 18, 31,
33, 45, 52, and 58
Screening -35 &45yrs
Cervical cancer
incidence from 19·8
(range 19·4–19·8) per
100000 women-years
Avert cases during next
century
Elimination could occur
Girls-only vaccination
before 9yrs
2·1 (2·0–2·6) cases 61·0 million (60·5–63·0)
cases
between2059 -2102
Girls-only vaccination
&twice-screening
0·7 (0·6–1·6) cases An extra 12·1 million (9·5–
1·7) case
accelerated elimination by
11–31 year earlier

20. Thank You