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Studies question cervical cancer eradication claims

Wednesday January 22nd, 2020

NHS officials produced new evidence of the success of HPV vaccination as a series of studies, published today, cast doubt on claims that cervical cancer could be eliminated.

At the weekend ministers and senior clinicians claimed the disease could be eradicated.

But the two latest studies point to problems with the screening programme and the vaccination programme.

In response, Public Health England today published its own analysis of the success of the HPV programme.

The charity Cancer Research UK is warning that rates of cervical cancer screening in the UK have been stalling and stagnating since the mid-2000s.

The figures, released today (22 January), show that uptake of the national cervical cancer screening programme, introduced in 1988, has failed to rise over the last decade.

Currently, fewer than 75% of eligible women attend cervical screening, with even lower attendance among younger age groups and in more deprived regions. Top reasons identified by the charity include embarrassment, fear of it hurting, feeling there is no need due to lack of symptoms or a perception of being at low risk.

The issue is being highlighted now, during cervical cancer prevention week.

Cancer Research UK’s chief executive Michelle Mitchell believes that greater awareness can have a large impact on uptake.

She says: “These figures show how research has protected thousands of people in the UK from cervical cancer, but they also highlight a worrying trend that shows progress is stalling and stagnating, which could undermine this success.

“Cervical cancer is one of the few cancers that can be prevented through screening, and now the disease is far less common in the UK. But these life-saving programmes can’t help people they can’t reach, which is why it’s important for us to continue to raise awareness and carry out research into how screening could be improved for hard-to-reach groups.”

Work is ongoing into new methods of testing such as urine tests and home testing kits, which could improve participation in screening.

* Researchers have reported a new analysis of the evidence for the effectiveness of HPV vaccines.

The analysis appears in the Journal of the Royal Society of Medicine today (22 January). It examines 12 randomised trials of the HPV vaccines Cervarix and Gardasil.

“Many methodological problems” were discovered in the design of these phase 2 and 3 efficacy trials, according to the authors, led by Dr Claire Rees of Queen Mary University of London, UK.

Dr Rees explains: “Trials may have overestimated efficacy by combining high-grade cervical disease with low-grade cervical changes that occur more frequently but often resolve spontaneously without progressing. We found insufficient data to clearly conclude that HPV vaccine prevents the higher-grade abnormal cell changes that can eventually develop into cervical cancer.

“Abnormal cell changes are likely to have been over-diagnosed in the trials because cervical cytology was conducted at six to 12 months rather than at the normal screening interval of 36 months. This, too, means that the trials may have overestimated the efficacy of the vaccine, again because some of the lesions would have regressed spontaneously.”

However, co-author Professor Allyson Pollock added: “We have good evidence that cervical screening significantly reduces the risk of cervical cancer in women regardless of whether they have been vaccinated.”

* Public Health England reported its own new data showing that fewer than 2% of sexually active girls aged 16 to 18 had HPV infection. Its last sample, taken in 2018, involved 585 young women and none were found to carry HPV16 or HPV18 infections.

The vaccination programme reached 83.9% of year nine schoolgirls in the last year.

Dr Vanessa Saliba, consultant epidemiologist at Public Health England, said: "This is clear evidence of the success of our immunisation programme, which continues to achieve high coverage.

"With millions of young women protected by HPV vaccination, we expect to see big reductions in cervical cancer in years to come and the introduction of the boys’ programme will accelerate this progress."

She added: "The prevalence of 3 other cancer-causing types, HPV31, 33 and 45, has also declined, suggesting the vaccine provides substantial cross-protection."

The NHS national clinical director for cancer Professor Peter Johnson added: "Thanks to a range of action set out in the NHS Long Term Plan and the new way of screening for cervical cancer which is now in place across the country, we hope that cervical cancer can be eliminated altogether."

Rees, C. P. et al. Will HPV vaccination prevent cervical cancer? Journal of the Royal Society of Medicine 22 January 2020; doi: 10.1177/0141076819899308

Tags: Cancer | Flu & Viruses | Infancy to Adolescence | NHS | UK News | Women's Health & Gynaecology

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