Shang‐Ying Hu

Efficacy and immunogenicity of AS04‐HPV‐16/18 vaccine in females with existing cervical HR‐HPV infection at first vaccination: A pooled analysis of four large clinical trials worldwide

AbstractFemales with existing high‐risk HPV (HR‐HPV) infections remain at risk of subsequent multiple or recurrent infections, on which benefit from HPV vaccines was under‐reported. We pooled individual‐level data from four large‐scale, RCTs of AS04‐HPV‐16/18 vaccine to evaluate efficacy and immunogenicity in females DNA‐positive to any HR‐HPV types at first vaccination. Females receiving the AS04‐HPV‐16/18 vaccine in the original RCTs constituted the vaccine group in the present study, while those unvaccinated served as the control group. Vaccine efficacy (VE) against new infections and associated cervical intraepithelial neoplasia (CIN) 2+ in females DNA‐negative to the considered HR‐HPV type but positive to any other HR‐HPV types, VE against reinfections in females DNA‐positive to the considered HR‐HPV type but cleared naturally during later follow‐up, and levels of anti‐HPV‐16/18 IgG were assessed. Our final analyses included 5137 females (vaccine group = 2532, control group = 2605). The median follow‐up time was 47.88 months (IQR: 45.72‐50.04). For the prevention of precancerous lesions related to the non‐infected HR‐HPV types at baseline, VE against HPV‐16/18 related CIN 2+ was 82.70% (95% CI: 63.70‐93.00%). For the prevention of reinfections related to the infected HR‐HPV types following natural clearance, VE against HPV‐16/18 12MPI was non‐significant (p > .05), albeit robust immunity persisted for at least 48 months. Females with existing HR‐HPV infections at first vaccination still benefit from vaccination in preventing precancers related to the non‐infected types at baseline. VE against reinfections related to the infected types following natural clearance remains to be further investigated.

Implementation of visual inspection with acetic acid and Lugol's iodine for cervical cancer screening in rural China

AbstractObjectiveTo address the value of visual inspection where HPV‐based screening is not yet available, we evaluated the real‐world effectiveness of visual inspection with acetic acid (VIA) and with Lugol's iodine (VILI) as a primary screening method for cervical cancer in rural China.MethodsA total of 206 133 women aged 30–59 years received two rounds of VIA/VILI screening for cervical cancer in 2006–2010. Women with positive screening results underwent colposcopy and direct biopsy, and were treated if cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was diagnosed. Clinical effectiveness of VIA/VILI was evaluated by process and outcome measures.ResultsThe VIA/VILI positivity rate, biopsy rate and detection rate of CIN2+ in the second round were significantly lower than in the first round. The 2‐year cumulative detection rate of CIN2+ varied from 0.53% to 0.90% among the four cohorts initiated in 2006, 2007, 2008, and 2009. The first round of screening detected 60%–83% of CIN2, 70%–86% of CIN3, and 88%–100% of cervical cancer. Over 92% of CIN2+ were found at the early stage.ConclusionMultiple rounds of visual inspection with continuous training and quality assurance could act as a temporary substitutional screening method for cervical cancer in resource‐restricted settings.

Temporal trends in cervical cancer incidence and mortality in economically emerging countries, 1992–2021: an age-period-cohort analysis

Introduction The economically emerging countries contributed to over half of the global cervical cancer (CC) burden and are good examples showing how rapid economic growth and health policy change affect the trends of CC burden. This study aimed to analyse the time trends of CC burden across Brazil, Russia, India, China and South Africa (BRICS) and associations with age, period and birth cohort from 1992 to 2021. Methods Data on CC incident cases, deaths, age-standardised incidence rates (ASIRs) and age-standardised mortality rates (ASMRs) were sourced from the Global Burden of Disease Study 2021 to demonstrate the temporal trends of CC burden for BRICS countries from 1992 to 2021. An age-period-cohort model was used to determine the net drift, local drift, longitudinal age curves, as well as period and cohort relative risks regarding CC incidence and mortality. Results Between 1992 and 2021, the ASIR of CC decreased from 16.5 to 15.6 per 100 000 women (−5.5%) and the ASMR declined from 10.1 to 6.7 per 100 000 women (−33.7%) in BRICS. Brazil reported continuous decreases in both CC incidence (net drift: −1.1%, 95% CI −1.1% to −1.0%) and mortality (net drift: −1.7%, 95% CI −1.80% to −1.6%). India also had reduced CC incidence and mortality but experienced worsening period effects from 2012 onwards. Russia and China experienced decreasing trends in mortality yet increasing trends in incidence, and there were apparent unfavourable trends among young and middle-aged women in Russia. South Africa maintained the highest CC incidence (40.0 per 100 000 women, 95% CI 35.0 to 45.6) and mortality (21.3 per 100 000 women, 95% CI 18.8 to 24.1) across the BRICS and had the steepest growth of CC incidence and mortality rates with increasing age. Conclusion Despite an overall decreasing trend of CC burden in BRICS, substantial heterogeneity exists across nations. Identifying country-specific priority groups and tailoring interventions is essential, and the patterns observed have implications for public health strategies applicable not just to BRICS nations but also to many other emerging economies facing substantial CC burden.

Cervical Cancer Incidence and Mortality Trends in China: The Role of Screening

In China, cervical cancer incidence and mortality have continued to increase despite more than 15 years of nationwide organized screening, raising questions about the population-level impact of screening. Using national cancer registry data from 2004 to 2018, we analyzed temporal trends in age-standardized incidence rates (ASIRs) and mortality rates (ASMRs), as well as age-specific rates, using Joinpoint regression, and assessed their correlations with age-specific screening coverage. From 2004 to 2018, ASIR increased from 6.06 to 11.81 per 100,000, but the annual growth rate slowed markedly after 2007, declining from 12.5 % (95 % CI: 9.7 ∼ 15.5 %) to 3.1 % (95 % CI: 2.7 ∼ 3.4 %). Among women aged 35-44 years, incidence trends shifted from a sharp rise to a sustained decline. By contrast, ASMR rose steadily from 2.07 to 3.44 per 100,000, with an average annual increase of 4.1 % (95 % CI: 3.4 ∼ 4.8 %). Notably, mortality stabilized after a rapid early rise among women aged 40-44 years, the group with the highest screening coverage. Correlation analysis revealed strong positive associations between higher screening coverage and the deceleration of incidence (ρ = 0.85, p < 0.001) and mortality trends (ρ = 0.69, p = 0.014). These findings suggest that increased screening coverage may already be moderating incidence and mortality trends in specific age groups, particularly women aged 35-44 years. However, nationwide declines have yet to emerge, especially in rural populations where screening coverage remains low and disease burden is high. Expanding access and improving screening quality are critical to accelerate progress toward cervical cancer control in China.