ASCO issues first global resource stratified guidelines for HPV vaccination for the prevention of cervical cancer.

ASCO today issued first guidelines on primary prevention of cervical cancer that can be used by physicians around the globe as it is tailored according to region, social and economic settings and healthcare resources available. The guidelines were published online in Journal of Global Oncology. [1]

HPV Vaccine 

The guidelines offer four levels of recommendations: basic, limited, enhanced and maximal based on the country’s healthcare circumstances and were developed by experts from multiple disciplines representing various countries across the globe.

The final recommendations were based on modified guidelines from WHO, CDC, and Canadian guidelines. 

Virtually all cervical cancers are caused by HPV infections and coverage with HPV vaccines in the female population could reduce up to 90% of cervical cancer incidence worldwide based on current vaccine availability and HPV worldwide distribution.

According to WHO “A large majority (around 85%) of the global burden occurs in the less developed regions, where it accounts for almost 12% of all female cancers.”  It further states that “Two HPV vaccines are now being marketed in many countries throughout the world - a bivalent and a quadrivalent vaccine. Both vaccines are highly efficacious in preventing infection with virus types 16 and 18, which are together responsible for approximately 70% of cervical cancer cases globally.”

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Currently, there are three prophylactic HPV vaccines approved and recommended in the United States, Europe, and many regions and countries: the bivalent (2vHPV; against HPV 16 and 18), quadrivalent (4vHPV; against HPV 6, 11, 16, and 18), and nine valent (9vHPV; against HPV 6, 11, 16, 18, 31, 33, 45, 52 and 58).

Although these guidelines specifically mention cervical cancer, vaccination also protects against other HPV-related cancers, such as other anogenital and potentially oropharyngeal cancers.

Vaccination strategy for girls.

So, in all resource settings two doses of HPV vaccines are recommended for girls age 9 to 14 years, with an interval of at least 6 months and possibly up to 12 to 15 months.

In maximal and enhanced settings, if the girls have reached age 15 or more and received the first dose before the age of 15 they may complete the series before age 26. If they did not receive any dose before 15 years than they should receive 3 doses and the series can be complete till 26 years of age.

In basic and limited resource setting, girls who received single dose can received additional dose between 15 to26 years if enough resources still exist for two dose vaccination among girls between 9-14years of age.

Vaccination strategy for boys.

In Basic settings boy’s vaccination is not recommended, while in limited, enhanced and maximal settings boys can receive vaccination if more than 50% of target female population are immunized, resources and infrastructure exist for boy's vaccination.. The same age related strategy should be applied as girls. This prevents the noncervical human papillomavirus–related cancers and diseases.

Vaccination strategies in special populations: These recommendations are uniform in all resource settings.

Women who are immunocompromised or HIV positive should be immunized according to the age group, but they should receive 3 doses.

Vaccines is not recommended in pregnant women nor women receiving treatment of cervical cancer precursor lesions (cervical intraepithelial neoplasia grade ≥ 2; eg, conization, loop electrosurgical excision process, or cryotherapy; all resource settings).

The latest vaccine coverage data by CDC shows that Six out of 10 teen girls (63 percent) and five out of 10 teen boys (50 percent) in the United States have started the HPV vaccination series (i.e., received at least one dose of HPV vaccine), according to data from the 2015 National Immunization Survey-Teen (NIS-Teen).[2]

The full text of the ASCO recent guidelines can be accessed here.

American Society of Clinical Oncology (ASCO) have released new resource stratified, evidence based global screening guidelines for secondary prevention of cervical cancer which can be accessed here.

The American Society of Clinical Oncology (ASCO) has issued recommendation on managing invasive cervical cancer which can be accessed here.

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[1] http://ascopubs.org/doi/full/10.1200/JGO.2016.008151

[2] https://www.cdc.gov/hpv/hcp/vacc-coverage.html