Will cervical cancer become a disease of the past? The prospect seems realistic in several countries, in a good position to eradicate pathologies linked to human papillomavirus (HPV). Leading the way: Australia, Northern European states, the United Kingdom, Canada and the United States. There, vaccination coverage exceeds 80%. France is lagging behind (43%). But the national vaccination campaign for all 5th grade students, organized from October in middle schools, aims to reduce this delay.
Sexually transmitted, HPV is the cause of several cancers, notably those of the cervix but also of the anus, throat and tongue. A vaccine that protects against papillomavirus infections has existed since 2006 and has proven its effectiveness. The countries which have recorded a strong reduction in the prevalence of certain HPV genotypes are also those where vaccination coverage of girls is high.
Australia, the pioneer
On this point, Australia is a pioneer. The country introduced anti-HPV vaccination in 2007 in schools. “From the outset, the number of young girls vaccinated was very high, around 80%, even though the country is large and with many disparities,” underlines François Margueritte, gynecologist and doctoral student in epidemiology in the laboratory. CESP of Inserm. The Australian approach has borne fruit: the papillomavirus infection rate fell by 92% among women aged 18-35, who were adolescents at the start of the program, according to a study published in 2018 in The Journal of Infectious Diseases.
The United Kingdom launched its campaign in 2008 aimed at girls aged 12-13. In Scotland, vaccination of adolescent girls led to a dramatic reduction in pre-invasive cervical disease (86% on average), reports a study published in the British Medical Journal in 2019. In the Nordic countries, vaccination programs have included anti-HPV control from the early 2010s.
These massive campaigns, which date back more than a decade, now make it possible to consolidate their positive effects on cervical cancer, the fourth most common among women worldwide and the main form of which is caused by HPV. In 2020, a Swedish study thus demonstrated the specific protection conferred by the vaccine: among women who had received the injections before the age of 17, cervical cancers decreased by 88%.
Vaccinate, screen, treat
These countries have all opened anti-HPV vaccination to boys: Australia, from 2013, the United Kingdom, in 2019, Sweden, in 2020… “Modelling estimated that it was also necessary to include adolescents to compensate for the remaining percentage of unvaccinated girls,” explains François Margueritte. Above all, vaccination helps protect boys against ENT cancers induced by the papillomavirus.
Australia now hopes to eradicate cervical cancer – or reduce its incidence to a threshold below 4 cases per 100,000 women per year, according to the World Health Organization (WHO) – by 2035. Professor Norbert Ifrah, president of the National Cancer Institute (INCa), is hopeful: “Countries that started their vaccination program in 2010 could have virtually eliminated cervical cancer by horizon 2040.”
But vaccination alone is not enough. It must be associated with screening as well as the treatment of precancerous lesions, “the three pillars necessary to eradicate cervical cancer,” adds François Margueritte.
Vaccination in schools, “an extraordinary booster”
Why is HPV vaccination in these countries so effective? Professor Norbert Ifrah highlights their common method: vaccinating in schools – “an extraordinary booster”. The culture of public health is also “superior compared to Latin countries”, notes the president of the INCa, who puts forward a final element of explanation: the increase in these States in cervical cancer, before the vaccine appeared. “At the end of the 1990s, when we began to be less afraid of AIDS, there was a certain relaxation on protections such as condoms, even if they only partially protect against HPV infections, and we observed, particularly in Australia and Sweden, a significant increase in cervical cancers. »
The two experts therefore welcome the decision of the French government to generalize the vaccine this fall to all 5th grade middle school students, with parental consent. Especially since studies show that the effectiveness of injections is much better when they are given early.