New vaccine to protect against 90 per cent of all cervical cancers, instead of the current 70 per cent
A new study by Cancer Council NSW, published in The Lancet Public Health, has looked at how the upcoming next-generation HPV vaccine will impact cervical cancer diagnosis and death in Australia. The study also estimated the conditions under which the next vaccine will remain cost-effective over the current vaccine.
First-generation HPV vaccines have been introduced in most developed countries. In Australia, 12-13-year old girls and boys have been offered the current vaccine – known as Gardasil – since 2007 and 2013 respectively. After the introduction of HPV vaccination, Australia experienced dramatic and rapid falls in vaccine-included HPV type infections, anogenital warts and cervical precancerous abnormalities. In women under 25, cervical abnormalities have already fallen by 36 per cent.
The next-generation vaccine has recently become available and has been approved for use in the USA and Europe. In Australia, the new vaccine is expected to be reviewed by the Pharmaceutical Benefits Advisory Committee for inclusion on the National Immunisation Program Schedule over the next year or so.
To see the impact that the new vaccine will make in Australia, the Cancer Council NSW study modelled the outcomes for three potential scenarios, and compared the lifetime risk of cervical cancer for each of them: a scenario in which 12-13-year old girls receive no vaccination, one where they receive the current vaccine, and one that sees them receive the next-generation vaccine. All scenarios assume that the vaccination takes place in a setting that has implemented primary HPV screening (as Australia will as of May 2017).
“We found that the switch to HPV screening alone reduces someone’s lifetime risk of cervical cancer by at least 18-20 per cent, compared to the current Pap test program – even if they’re not vaccinated,” Professor Karen Canfell, Director of Research at Cancer Council NSW, said.
Girls who have been given the current vaccine are predicted to experience an additional reduction of 54 per cent. Those in future cohorts who receive the next-generation vaccine are estimated to experience a further reduction of another 11 per cent. Girls offered either vaccine are also at substantially lower risk of precancer treatment.
“We expect the impact of the next-generation vaccine to be smaller in males, since the large majority of HPV-related cancers in men are associated with the two HPV types (HPV 16/18) already included in first generation vaccines,” Canfell said. However, men and women will indirectly benefit – the more people receive the vaccine, the harder it becomes for the virus to circulate in the community.
The study also found that in order for the new vaccine to remain a cost-effective alternative to the current one, the additional cost-per-dose shouldn’t exceed $23-$36.
“The existing vaccination program is already incredibly effective, as evidenced by the fall in cervical abnormalities in the last decade. Even though the next-generation vaccine is estimated to be even more effective at lowering women’s risk of cervical cancer, it is essential that women keep screening for cervical cancer regularly.
“Right now, women should get a Pap smear every two years, and as of May 2017, it is recommended they get an HPV test every five years as of age 25.”
[hr] Source: Cancer Council NSW
 Under the assumption that two doses are administered, that there is lifelong protection, and that there are no additional costs for boys.