Journal of Public Health

Maximizing impact: the power of early HPV vaccination for long-term protection―lessons from a systematic review and meta-regression analysis

Abstract Background This systematic review and meta-regression analysis assessed the impact of human papillomavirus 16/18 (HPV16/18)-AS04 vaccine (Cervarix®) on advanced cervical lesions, including grade 3 cervical intraepithelial neoplasia or worse (CIN3, CIN3+), or cervical cancer, highlighting age-at-vaccination–dependent vaccine efficacy and effectiveness. Methods Studies reporting HPV16/18-AS04 vaccine efficacy or effectiveness were included with an intervention group receiving HPV16/18-AS04 vaccine and comparator group receiving placebo, another vaccine or being unvaccinated. Of 53 articles identified, nine were selected. Meta-analysis and meta-regression models with random effects and data-driven model selection determined vaccine effects (VEs) and impactful covariates. Results HPV16/18-AS04 vaccine effectively prevented advanced cervical premalignant lesions and cancer in adolescent girls and women vaccinated at 12–25 years. Combined randomized controlled trials and observational studies VEs on CIN3+ ranged between 76.78% (95% CI 28.15–92.49) for HPV16/18 and 56.19% (95% CI 24.76–74.49) irrespective of HPV type. Vaccine effectiveness was greatest in those vaccinated at the youngest ages. Conclusions HPV16/18-AS04 vaccine provides long-term protection against cervical premalignant lesions and cervical cancer in both controlled and real-world settings, particularly when administered at younger ages. The evidence urges policymakers and the community to ensure HPV vaccination begins at the youngest recommended ages.

Trends in access to female cancer screening in Brazil, 2007–16

Abstract Background This study aims to analyse changes in the prevalence of cervical cancer (CCa) and breast cancer (BCa) screening among women in the Brazilian capitals and Federal District in the last decade (2007–16). Methods Data from the surveillance system of risk and protective factors for chronic diseases through telephone interviews (n = 267 949) were used. Adequate screening consisted of, at least, one Pap test triennially, for women aged between 25 and 64 years, and mammography exam biannually, for women aged between 50 and 69 years. The prevalence of adequate screening was investigated for each type of cancer isolated and combined (women aged between 50 and 64 years). The prevalence of adequate screening was estimated for the total population and according to socioeconomic variables. Linear regression models were used. Results The prevalence of adequate screening test for CCa remained stable, around 82%, while the screening test for BCa increased from 71 to 78% between 2007 and 2016. Higher increases were observed among women with low schooling and from less developed regions. The percentage of adequate screening (considering both types), for women aged between 25 and 69 years, remained stable, close to 78%. Conclusions Screening for BCa increased significantly. Smaller coverage rates are verified among women with low schooling and from less developed regions.

Awareness of HPV-related cancers and the HPV vaccination programme in Scotland: a cross-sectional study of gender, deprivation and knowledge gaps

Abstract Background Scotland’s human papillomavirus (HPV) vaccination programme includes boys, yet awareness of male-associated cancers and eligibility remains unclear. Awareness may differ by gender and socioeconomic status, contributing to inequalities and declining uptake. This study assessed knowledge of HPV, HPV-related cancers and the vaccination programme. Methods A cross-sectional online survey (n = 1052) was conducted in 2023. Descriptive statistics and logistic regression explored gender- and deprivation-related differences in awareness of HPV, HPV-related cancers and the vaccination programme. Results Overall, 80.6% had heard of HPV, with higher awareness among females (89.2%) than males (67.3%, P < .001) and in less deprived areas (88.8% vs. 79.8%, P = .004). Cervical cancer was recognized (78.9% females, 54.8% males), while awareness of non-cervical cancers was low, especially oropharyngeal (<10%). Fewer than half (48.9%) knew boys are included in Scotland’s programme. Vaccine awareness strongly predicted knowledge of male cancers (adjusted odds ratio [aOR] = 4.41) and the boys’ programme (aOR = 10.67). Despite knowledge gaps, willingness to vaccinate children remained high (>92%). Conclusions Awareness of male HPV-related cancers and the boys’ vaccination programme remains limited, with gender and socioeconomic disparities. A ‘knowledge-action gap’ was evident, with support despite poor understanding. Targeted, inclusive education is needed to reduce inequalities and sustain confidence.

Income and education inequalities in cervical cancer incidence in Canada, 1992–2010

ABSTRACT Background There is evidence of socioeconomic inequalities in cancer incidence in Canada and other countries globally, yet there is no study investigating socioeconomic inequalities in national cervical cancer incidence in Canada. Thus, the current study investigated income and education inequalities in the incidence of cervical cancer in Canada from 1992 to 2010. Methods Data were derived from a linked dataset that combined cervical cancer incidence from the Canadian Cancer Registry and demographic and socioeconomic information from the Canadian Census of Population and the National Household Survey. The Concentration index approach was used to measure income and education inequalities in the incidence of cervical cancer over time. Results National incidence of cervical cancer decreased significantly from 1992 to 2010. The age-standardized C was negative for the majority of years for both income and education inequalities, but the preponderance were not significant. Trend analyses of socioeconomic inequalities suggested an increasing concentration of cervical cancer incidence among less-educated females over the study period. Conclusions Over almost two decades, there were no pervasive socioeconomic inequalities in the incidence of cervical cancer in Canada. As such, policies aimed at reducing the incidence of cervical cancer should focus on the general population, irrespective of socioeconomic status.

Performance characteristics of the point-of-care tests for HPV-based cervical cancer screening: a systematic review and meta-analysis

Abstract Background We aimed to conduct an updated and comprehensive summary of the sensitivity and specificity of three human papillomavirus (HPV) point-of-care (POC) tests (careHPV™, oncoE6™ cervical test, Xpert® HPV) to guide resource-constrained countries for their implementation in cervical cancer screening. Methods Databases including Medline, Embase, Web of Science and cumulated index in nursing and allied health literature (CINAHL) were searched between January 2004 and October 2024. Observational studies analyzing the three tests for cervical cancer screening were included. Pooled estimates for the performance characteristics were calculated using random-effect models. Findings Of the 3976 records, 33 studies were included. The sensitivity and specificity of careHPV™ for detection of CIN2+ lesions in self-collected samples were 75.6% and 85.6% compared to 86.4% and 80.4% for physician-collected samples. The sensitivity and specificity of OncoE6™ cervical test were 54.5% and 98.4%, respectively, for physician-collected samples. Xpert® HPV had a sensitivity and specificity of 91.5% and 56.5% in self-collected vaginal samples (SCSs), 92.3% and 53.3%, respectively, in physician-collected cervical samples. Interpretation Both careHPV™ and Xpert® HPV have a good sensitivity and specificity as a POC cervical cancer screening method. These methods also hold potential for use on SCSs. Funding None.

Factors associated with cervical screening coverage: a longitudinal analysis of English general practices from 2013 to 2022

Abstract Background Cervical cancer remains an important global public health concern. Understanding the factors contributing to a decline in screening uptake in high-income countries is fundamental to improving screening rates. We aimed to identify general practice and patient characteristics related to cervical screening coverage in England between 2013 and 2022. Methods We analyzed a panel of 59 271 General Practice (GP)-years from 7881 GP practices. We applied correlated random effects regression to examine the association between cervical screening uptake and a rich set of GP practice workforce, size, quality and patient characteristics. Results Our results show a decline in overall screening rates from 2013/14 to 2021/22 from 77% to 72%. We find GP workforce and list size characteristics are strongly related to screening rates. An increase in 1 FTE Nurse per 1000 patients is related to a 1.94 percentage point increase in cervical screening rates. GP practices located in more deprived areas have lower screening rates. Conclusions GP workforce and patient characteristics need to be considered by decision-makers to increase screening rates. The implementation of self-sampling screening methods could help address some of the current barriers to screening, including lack of healthcare staff and facilities.

Impact of new consent procedures on uptake of the schools-based human papillomavirus (HPV) vaccination programme

Abstract Background Local policy change initiating new consent procedures was introduced during 2017–2018 for the human papillomavirus (HPV) vaccination programme year in two local authorities in the south–west of England. This study aims to assess impact on uptake and inequalities. Methods Publicly available aggregate and individual-level routine data were retrieved for the programme years 2015–2016 to 2018–2019. Statistical analyses were undertaken to show: (i) change in uptake in intervention local authorities in comparison to matched local authorities and (ii) change in uptake overall, and by local authority, school type, ethnicity and deprivation. Results Aggregate data showed uptake in Local Authority One increased from 76.3% to 82.5% in the post-intervention period (risk difference: 6.2% P = 0.17), with a difference-in-differences effect of 11.5% (P = 0.03). There was no evidence for a difference-in-differences effect in Local Authority Two (P = 0.76). Individual-level data showed overall uptake increased post-intervention (risk difference: +1.1%, P = 0.05), and for young women attending school in Local Authority One (risk difference: 2.3%, P < 0.01). No strong evidence for change by school category, ethnic group and deprivation was found. Conclusion Implementation of new consent procedures can improve and overcome trends for decreasing uptake among matched local authorities. However, no evidence for reduction in inequalities was found. Implications and discussion The new consent procedures increased uptake in one of the intervention sites and appeared to overcome trends for decreasing uptake in matched sites. There are issues in relation to the quality of data which require addressing.