Prognosis of incidence and mortality from cervical cancer in Russia depending on vaccination against HPV

Abstract

Human papilloma virus (HPV) is carcinogenic to humans and causes cervical cancer, as well as cancers of the vagina, vulva, penis, anus and oropharynx both in men and women. Based on this evidence the vaccines against HPV have been developed, registered and a recommended for use. These include bivalent vaccine (CERVARIX), quadrivalent vaccine (GARDASIL) and nonavalent vaccine (GARDASIL9). The effectiveness and safety of these vaccines were shown in the randomized clinical trials as well as in the real life in the countries where vaccination of girls aged 12–13 years was started in 2007–8. Vaccination prevents: a) HPV infection among vaccinated, b) cervical intraepithelial neoplasia (CIN) and c) invasive cervical cancer.World health organization (WHO) strategy to eliminate cervical cancer proposes the following targets that must be met by 2030: 90% of girls fully vaccinated by age 15; 70% women screened by 35 and again in 45 years of age. The goal of WHO is the decrease cervical cancer incidence to 4 cases per 100 000 population.In Russia the incidence of cervical cancer is on increase since early 1990 s and further rise is predicted. Mortality from cervical cancer has slightly increased in early 1990 s and since has stabilized. In 2019 the incidence (age standardized rates) of cervical cancer was 15,4 and mortality 5,6 per 100 000 population. The number of newly diagnosed cases was 17 500 and amount of dearth from cervical cancer – 6300.In this paper we assess the number of the preventable cervical cancer cases and death from this disease in women aged 15–79 years during the forthcoming years of 21 century as a result of the HPV vaccination of girls born in 2009–2018, 2019–28, 2029–2038. The prognosis is based on the incidence and mortality from cervical cancer in 2018 and predicted rates for 2032. Our assumption was that of 90% of girls under 15 years will be covered by vaccination and the effectiveness of vaccination will be 79,80% in decrease of the HPV prevalence.The estimates based on 2018 statistics suggest that among women born in 2009–2038 years – 348 850 will be diagnosed with cervical cancer and 117 862 will die from it. The timely vaccination of 90% of girls will prevent 250544 cases and 84648 deaths from cervical cancer. Based on the estimated incidence and mortality for 2032 among these cohorts of women 470 729 will be diagnosed with and 130 811will die from cervical cancer. vaccination will prevent 338 078 cases of disease and save 93 948 lives.We have shown that vaccination results in the decrease in incidence and mortality from cervical cancer and will save hundred thousands of lives. This is the strongest argument for urgent implementation of vaccination program in Russia. An additional important task is the assessment of economic impact of vaccination in comparison with the heavy burden imposed by disease and deaths from cervical cancer. The financial losses due to high incidence and mortality from cervical cancer or any other disease in addition to the costs of treatment include demographic and social factors. The latter will have largest impact on the economy and wellbeing of the country.Therefore the next step of our study will be the analyses of the cost-effectiveness of HPV vaccination in the cohort of 24 million women born in 2009–2038 based on the predicted in this paper incidence and mortality of cervical cancer and number of disease and deaths that will be prevented by vaccination.