Background

WHO has launched an initiative aiming to eliminate cervical cancer as a public health problem. Elimination is a long-term target that needs long-lasting commitment. To support local authorities in implementing human papillomavirus (HPV) vaccination, we provide regional and country-specific estimates of cervical cancer burden and the projected impact of HPV vaccination among today's young girls who could develop cervical cancer if not vaccinated.

Methods

The expected number of cervical cancer cases in the absence of vaccination among girls born between 2005 and 2014 was quantified by combining age-specific incidence rates from GLOBOCAN 2018 and cohort-specific mortality rates by age from UN demographic projections. Preventable cancers were estimated on the basis of HPV prevalence reduction attributable to vaccination and the relative contribution of each HPV type to cervical cancer incidence. We assessed the number of cervical cancer cases preventable through vaccines targeting HPV types 16 and 18, with and without cross-protection, and through vaccines targeting HPV types 16, 18, 31, 33, 45, 52, and 58.

Findings

Globally, without vaccination, the burden of cervical cancer in these birth cohorts is expected to reach 11·6 million (95% uncertainty interval 11·4–12·0) cases by 2094. Approximately 75% of the burden will be concentrated in 25 countries mostly located in Africa and Asia, where the future number of cases is expected to increase manyfold, reaching 5·6 million (5·4–6·0) cases in Africa and 4·5 million (4·4–4·6) cases in Asia. Worldwide immunisation with an HPV vaccine targeted to HPV types 16 and 18, with cross-protection against HPV types 31, 33, and 45, could prevent about 8·7 million (8·5–9·0) cases.

Interpretation

Detailed estimates of the increasing burden of cervical cancer and projected impact of HPV vaccination is of immediate relevance to public health decision makers. Shifting the focus of projections towards recently born girls who could develop cervical cancer if not vaccinated is fundamental to overcome stakeholders' hesitancy towards HPV vaccination.

Funding

Bill & Melinda Gates Foundation, Canadian Institutes of Health Research.

中文翻译：

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2005 年至 2014 年出生女孩预期和可预防宫颈癌的全球估计：出生队列分析

背景

世界卫生组织发起了一项旨在消除宫颈癌这一公共卫生问题的倡议。消除是一个长期目标，需要长期的承诺。为了支持地方当局实施人乳头瘤病毒 (HPV) 疫苗接种，我们提供了特定区域和国家的宫颈癌负担估计值，以及 HPV 疫苗接种对当今如果不接种疫苗可能患宫颈癌的年轻女孩的预计影响。

方法

通过结合 GLOBOCAN 2018 中的特定年龄发病率和联合国人口预测中按年龄划分的队列特定死亡率，对 2005 年至 2014 年出生的女孩中未接种疫苗的宫颈癌病例的预期数量进行了量化。可预防的癌症是根据疫苗接种导致的 HPV 患病率降低以及每种 HPV 类型对宫颈癌发病率的相对贡献来估计的。我们评估了通过针对 HPV 16 和 18 型的疫苗（有或没有交叉保护）以及通过针对 HPV 16、18、31、33、45、52 和 58 型的疫苗可预防的宫颈癌病例数。

发现

在全球范围内，如果不接种疫苗，到 2094 年，这些出生队列中的宫颈癌负担预计将达到 11·6 百万（95% 不确定性区间 11·4–12·0）例。大约 75% 的负担将集中在 25主要位于非洲和亚洲的国家，未来病例数预计将增加数倍，非洲达到 5·600 万（5·4–6·0）例，非洲达到 4·500 万（4·4–4·6） ）亚洲的案例。在全球范围内使用针对 HPV 16 和 18 型的 HPV 疫苗进行免疫，并针对 HPV 31、33 和 45 型进行交叉保护，可以预防约 8·7 百万 (8·5–9·0) 例病例。

解释

对日益增加的宫颈癌负担和 HPV 疫苗接种的预计影响的详细估计与公共卫生决策者直接相关。将预测的重点转向最近出生的女孩，如果不接种疫苗，她们可能会患上宫颈癌，这对于克服利益相关者对 HPV 疫苗接种的犹豫不决至关重要。

资金

比尔及梅琳达·盖茨基金会、加拿大健康研究所。