Content area
Full Text
Correspondence to: L Rahangdale [email protected]
Introduction
The progression of cervical cancer is well characterized (fig 1).12 High risk human papillomavirus (hrHPV) infects metaplastic cells at the cervical transformation zone and integrates into the host genome,3 leading to inactivation of the tumor suppressor genes p53 and Rb, cell proliferation, and accumulation of mutations.4 Genetic predisposition, hormonal factors, host immune response, and cigarette smoking increase susceptibility to hrHPV infection..3 As persistent human papillomavirus infection is the central cause of invasive cervical squamous cell carcinoma (ICC),5 and pre-cancerous lesions are generally detectable, prevention of cervical cancer relies primarily on preventing infection through human papillomavirus vaccination (primary prevention) and detecting and treating pre-cancerous lesions (also known as high grade cervical intraepithelial neoplasia (CIN2/3) or adenocarcinoma in situ (ACIS)) before they progress to cancer (secondary prevention).
The first human papillomavirus vaccine was introduced into clinical care in 2006.6 Bivalent (human papillomavirus 16/18), quadrivalent (human papillomavirus 6/11/16/18), and nonavalent (human papillomavirus 6/11/16/18/31/33/45/52/58) vaccines are prequalified by the World Health Organization and widely licensed.7 All available vaccines provide protection against human papillomavirus 16 and 18, as approximately 70% of cervical cancers worldwide are attributable to these two virus types5; the nonavalent vaccine prevents subtypes that account for an additional 19%.8
WHO set a target for 194 countries to adopt human papillomavirus vaccination by 2030 in its Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem.9 By 2020, however, only 114 countries had introduced human papillomavirus vaccines; most of these are high income countries.10 Less than 25% of low income countries have human papillomavirus vaccination as part of their national immunization schedules. Most gaps in the introduction and coverage of human papillomavirus vaccine are in regions of Africa and Asia where the burden of cervical cancer is also high.10
Global efforts to nearly eliminate cervical cancer focus on expanding access to human papillomavirus vaccination and cervical cancer screening.9 In this article, we summarize clinical data on the efficacy and effectiveness of human papillomavirus vaccination, its potential impact on incidence of ICC, and strategies to increase access to and uptake of vaccination for general practitioners and specialists in positions to offer...