Eliminating cervical cancer: How it could be done

Cervical cancer is one of the most preventable cancers, but too few young women are vaccinated against HPV infections. The WHO wants to take action against this with a worldwide strategy.

WHO strategy points the way

Cervical cancer is one of the most preventable cancers, but too few young women are vaccinated against HPV infections as the main trigger. The WHO wants to take action against this with a worldwide strategy.

In Germany, only 43% of all 15-year-old girls have the maximum possible protection against human papilloma viruses (HPV), reports the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ). Only with a vaccination rate of at least 70% can protection be assumed to be universal, the report says. For comparison: In Australia and in many Scandinavian countries, vaccination rates are around 80%.

And high vaccination rates are urgently needed: Every year, about 7,700 people in Germany still contract HPV-related cancer - mostly cervical carcinomas.

WHO: Global strategy to tackle cervical cancer

Germany is not alone in its challenges - numerous nations report low vaccination rates against HPV. That is why the World Health Organisation has developed global strategies with three pillars: vaccination, screening and treatment. Successful implementation could help prevent more than 40% of all new cases and five million deaths by 2050. Together, 194 countries aim to achieve the following goals by 2030:

In their policy paper, the WHO experts emphasise that governments achieve high returns on investment in such programmes. An estimated $ 3,20 (€ 2,65 ) will be returned to the economy for every dollar (€ 0,83) invested, as women's employment increases worldwide. The figure increases to $ 26,00 per US dollar invested when the benefits to the entire economy, including families and the health system, are considered.

Strategies for Germany

Where do we go from here? Necessary measures differ from nation to nation. For Germany, the DKFZ has presented comprehensive approaches in several areas:

New indications for vaccines in sight?

The spectrum of possible uses for HPV vaccines is far from exhausted. An example from research: Scientists from the Netherlands have shown that an experimental vaccine against the high-risk HPV type HPV 16 improves the effectiveness of chemotherapies for cervical cancer. Their idea: E6 and E7 are oncogenic proteins that are only produced by HPV-16 but do not occur in the human body. Immunotherapy is directed against them.

A phase I/II study included 77 patients with advanced, recurrent cervical cancer. In these patients, the combination of a therapeutic vaccine with two standard chemotherapies improved overall survival. 43% of all participants achieved tumor regression and another 43%  had stabilised cancer. Patients who had a stronger response to the vaccine had a longer median overall survival of 16.8 months compared to women with weaker responses (11.2 months). There was no placebo arm in the study. Nevertheless, the results showed therapeutic potential uses for HPV vaccines, the article says.

1. DKFZ press release: "Vaccinated in youth - protected against cancer later", 2 March 2021. (Original title in German:
„In der Jugend geimpft – später vor Krebs geschützt“
2. WHO Press release "A cervical cancer-free future: First-ever global commitment to eliminate a cancer", 17 November 2020.
3. DKFZ: Vaccination against HPV infections, 2020, online at https://www.dkfz.de/de/krebspraevention/AdWfdP_2020_Impfung-gegen-HPV-Infektionen.pdf
4. Melief, CJM et al. (2020) Strong vaccine responses during chemotherapy are associated with prolonged cancer survival. Sci Transl Med 2020 Mar 18;12(535):eaaz8235. doi: 10.1126/scitranslmed.aaz8235