This is the first guideline on primary prevention of cervical cancer.
‘The guideline provides expert guidance on primary prevention of cervical cancer by using HPV vaccination to reduce human papillomavirus (HPV) infection.’
It targets multiple regions of the world with different levels of socio-economic and structural resource settings, offering evidence-based guidance to health care providers worldwide.
The guideline includes recommendations according to four levels of resource settings-basic, limited, enhanced and maximal.
The levels include financial resources of a country or region and the development of its health system.
Cervical cancer is the fourth most common cancer among women worldwide. Lesser developed regions face a large and disproportionate burden of the disease.
In these regions including Africa and Latin America, about 85% of cervical cancer related diagnoses and 87% of cervical cancer deaths occur.
Most cases of cervical cancers are caused by HPV infection.
Vaccination Guidelines Based on Different Levels of Resource Settings
Independent of the resources settings:
- two doses of HPV vaccine are recommended for girls ages 9 to 14 years, with an interval of at least 6 months and up to 12 to 15 months between doses
- girls who are HIV positive should receive three doses
For maximal and enhanced resource settings:
- girls who are 15 years or older and have received their first dose before age 15, they may complete the two-dose series
- if they have not received the first dose before age 15, they should receive three doses
- vaccination may be given through age 26 years, in both cases
For limited and basic resource settings and for boys:
- girls who received one dose may receive additional doses between ages 15 and 26 years, if sufficient resources remain after vaccinating girls 9 to 14 years
- boys may be vaccinated in all settings, if there is at least a 50% coverage in priority female target population, sufficient resources, and such vaccination is cost effective
"Because resource availability varies widely, both among and within countries, we need to adjust strategies to improve access to HPV vaccination everywhere," said Silvia de Sanjosé, MD, PhD, co-chair of the Expert Panel that developed the guideline and head of the Cancer Epidemiology Research Program at Institut Català d'Oncologia in Barcelona, Spain.
"This guideline is unique in offering cervical cancer vaccination recommendations that can be adapted to different resource levels and we expect it to have a major impact on the global health community." Sanjosé added.
"Although HPV vaccine has been around for more than a decade, the uptake of the vaccine has been less than ideal in many places, including in high-resource countries such as the United States," said Silvina Arrossi, PhD, co-chair of the Expert Panel that developed the guideline and an official and researcher at the Instituto Nacional del Cancer in Buenos Aires, Argentina. "As an organization of cancer doctors, ASCO continues to endorse HPV vaccination programs and efforts to help spare more women around the world from this very difficult cancer."
The findings are published in the Journal of Global Oncology
- Silvina Arrossi et al. Primary Prevention of Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Guideline. Journal of Global Oncology; (2017) doi.org/10.1200/JGO.2016.008151