First global guidance for HPV vaccination for cervical cancer prevention

The American Society of Clinical Oncology (ASCO) hasissued a clinical practice guideline on human papillomavirus (HPV) vaccination for the prevention of cervical cancer. This is the first guideline on primary prevention of cervical cancer that is tailored to 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 specific recommendations according to four levels of resource settings: basic, limited, enhanced and maximal. The levels pertain to financial resources of a country or region, as well as the development of its health system – including personnel, infrastructure and access to services. The guideline complements ASCO’s two other global, resource-stratified guidelines on cervical cancer, also stratified to these four levels of resources.

Key guideline recommendations:

  • In all environments and independent of the resource settings, two doses of human papillomavirus 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:
    • If girls 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;
    • In both scenarios vaccination may be given through age 26 years.
  • For limited and basic resource settings: if sufficient resources remain after vaccinating girls 9 to 14 years, girls who received one dose may receive additional doses between ages 15 and 26 years.
  • Vaccination of boys: in all settings, boys may be vaccinated, if there is at least a 50percent coverage in priority female target population, sufficient resources, and such vaccination is cost effective.

Cervical cancer is the fourth most common cancer among women worldwide, with less developed regions suffering a disproportionate burden from the disease. In fact, 85percent of cervical cancer diagnoses and 87percent of cervical cancer deaths occur in less developed regions, including parts of Africa and Latin America.

‘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 Sanjose, MD, PhD, co-chair of the Expert Panel that developed the guideline and head of the Cancer Epidemiology Research Program at Institut Catala 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.’