Observational
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The human papillomavirus, or HPV, vaccine is cutting cases of cervical cancer right across the socio-economic spectrum, with most cases being prevented in more deprived groups, according to a major study funded by Cancer Research UK.
Until now, there had been concerns that the HPV vaccine could have an unequal impact across society. After carrying out the longest follow-up on the effectiveness of the HPV vaccine, researchers at Queen Mary University of London concluded the HPV vaccination programme in England is helping to close some inequalities in cervical cancer. *
Due to a typically higher incidence of cervical cancer in more deprived groups, researchers found that more cases were prevented in the most deprived group (around 190), compared to the least deprived group (around 60). **
Published in the BMJ medical journal, the data reflected the huge success of the school-based vaccination programme, showing that well-executed public health interventions can help to reduce health inequalities.
Today’s news adds even more weight to evidence that HPV vaccination works. Researchers found that over a 12-year period, the vaccine reduced cervical cancer incidence rates by nearly 90% and pre-cancerous conditions by around 95% in women who were offered routine vaccination at 12-13 years old in England. The study shows that the vaccine is much more effective when taken up by people in year 8 (aged 12-13) than later in life.
Although the life-saving HPV vaccine currently reaches people from all backgrounds, Cancer Research UK warns that some inequalities remain in cervical cancer incidence, and more work is needed to improve the health of the most deprived groups. Uptake of the HPV vaccine in the UK has also fallen in recent years.
Overall, cervical cancer rates are higher in people from deprived backgrounds across the UK. Researchers said this is partly due to people being at greater risk from HPV and barriers that can drive lower screening attendance.
Professor Peter Sasieni, lead author from Queen Mary University of London, said:
“Our research highlights the power of HPV vaccination to benefit people across all social groups.
“Historically, cervical cancer has had greater health inequalities than almost any other cancer and there was concern that HPV vaccination may not reach those at greatest risk. Instead, this study captures the huge success of the school-based vaccination programme in helping to close these gaps and reach people from even the most deprived communities.
“In the UK, the elimination of cervical cancer as a public health problem in our lifetime is possible with continued action to improve access to vaccination and screening for all.”
The HPV vaccine, combined with cervical screening, can dramatically reduce cervical cancer incidence to the point where almost no one develops it. Improving people’s access to both programmes is at the heart of NHS England’s recent pledge to eliminate cervical cancer as a public health problem by 2040. ***
This research, however, lands when uptake of the HPV vaccine and screening attendance has fallen in recent years across the UK and coverage rates are yet to recover from the disruption of the COVID pandemic.
With huge progress in tackling cervical cancer at risk of stalling, Cancer Research UK is encouraging all eligible people to take up the offer of vaccination and screening. The charity is also calling on the UK Government to ensure both programmes in England are backed by sufficient resources and modern IT infrastructure.
Cancer Research UK’s senior health information manager, Sophia Lowes, said:
“Every year, around 3,300 people receive a cervical cancer diagnosis in the UK. This research shows us that HPV vaccination works, and increased coverage can help to bring about a future virtually free from this disease.
"But we can't lose momentum. We're calling for targeted action to ensure that as many young people as possible get the lifesaving HPV vaccine. Better reporting on uptake by deprivation and ethnicity, along with more research, will help us understand how to reach those most at risk.
"We encourage people to take up the HPV vaccine if they are eligible. If you are concerned that you or your child has missed out on the HPV vaccine, you can contact your child’s school nurse, school immunisation service or GP surgery to find out more."
Cancer Research UK scientists helped to prove the link between HPV and cervical cancer 25 years ago. This discovery put the gears in motion for the HPV vaccination programme and improved cervical cancer screening. Thanks to these scientific developments, cervical cancer rates in the UK have fallen by almost a third since the early 1990s. ****
The HPV vaccination programme was first introduced to England in 2008. Since then, girls aged 11-13 in the UK have been offered the vaccine and since September 2019, boys of the same age can also get it. Anyone who missed their vaccine can request it through the NHS up to the age of 25.
It’s also available to men who have sex with men and some transgender people up to the age of 45 through sexual health and HIV clinics.
Cancer Research UK chief executive, Michelle Mitchell OBE, said:
“Today’s news is promising – the HPV vaccination programme is paving the way to make cervical cancer a rare disease for all.
“The UK Government and the NHS must continue to work with communities and services, so the HPV vaccine is taken up by as many eligible people as possible, and accurate information reaches those who most need it.
“We want to see a world where everyone shares in this scientific and research progress equally.”
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CRUK spokespeople and study researchers are available for interview. Case study information is available upon request. For media enquiries please contact Anna Cawdron in the Cancer Research UK press office on 020 3469 8928 and anna.cawdron@cancer.org.uk or via press out of hours, 020 3469 8301.
Notes to editor:
* Embargoed link to research: http://press.psprings.co.uk/bmj/may/HPV.pdf
Public link once embargo lifts: https://www.bmj.com/content/385/bmj-2023-077341
The study was conducted by researchers at Queen Mary University of London, together with colleagues at the UK Health Security Agency and NHS England. In the longest timeframe to date, researchers looked at pre-cancerous and invasive cervical cancers diagnosed in England in women aged 20-64 between 2006 and mid-2020.
To represent socio-economic deprivation, researchers used the Index of Multiple Deprivation (IMD). This is a small-area measure based on several domains of deprivation (e.g. income, employment, health and crime).
** This study included approximately 650,000 people offered vaccination aged 12-18 in each of the five deprivation groups.
*** Nearly all cases of cervical cancer are caused by HPV. HPV infects the skin and cells lining the inside of the body. Most people, regardless of gender, will have HPV at some point in their lifetime and the infection usually gets better on its own. For every 100 people who attend cervical screening, around 13 people will receive a positive HPV result. If left untreated, these HPV infections can sometimes lead to cancer. This process takes many years.
The HPV vaccine protects against the main cancer-causing strains of the virus, and some strains which cause genital warts. Vaccinating people against the infection helps to prevent abnormal changes in cervical cells, in turn leading to fewer cases of cervical cancer.
In the UK, cervical screening tests for high-risk strains of HPV, and if it is detected, looks for abnormal cell changes. By finding and treating these changes, it aims to prevent cervical cancer from developing. The screening programme is for women, some transgender men and some non-binary people – everyone with a cervix. In the UK it’s offered to those aged 25 to 64.
**** Based on the percentage change in incidence rates from 14 cases per 100,000 women in the UK between 1991-1993 to 10 cases per 100,000 women between 2017-2019.
Cancer Research UK also funds research to ensure more people in low- and middle- income countries can be fully vaccinated against HPV. Around 90% of cases and deaths from cervical cancer occur in low and middle-income countries due to limited access to vaccination, screening, and treatment options.
Information about NHS England’s pledge to eliminate cervical cancer by 2040 can be found here.
NHS guidance on HPV vaccination can be found here, and cervical screening here.
Previous research on the effectiveness of the HPV vaccine can be found here.
About Cancer Research UK:
Cancer Research UK is the world’s leading cancer charity dedicated to saving lives through research, influence and information.
Cancer Research UK’s pioneering work into the prevention, diagnosis and treatment of cancer has helped save millions of lives.
Cancer Research UK has been at the heart of the progress that has already seen survival in the UK double in the last 50 years.
Today, 2 in 4 people survive their cancer for at least 10 years. Cancer Research UK wants to accelerate progress and see 3 in 4 people surviving their cancer by 2034.
Cancer Research UK supports research into the prevention and treatment of cancer through the work of over 4,000 scientists, doctors and nurses.
Together with its partners and supporters, Cancer Research UK is working towards a world where people can live longer, better lives, free from the fear of cancer.
For further information about Cancer Research UK's work or to find out how to support the charity, please call 0300 123 1022 or visit www.cancerresearchuk.org. Follow us on Twitter and Facebook
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