Streamlining the WHO cervical cancer elimination goal
Menée en Inde à partir des données d'un essai randomisé portant sur 14 277 participantes (durée médiane de suivi : 9 ans), cette étude évalue, 10 ans après la vaccination, l'efficacité de la protection contre une infection persistante par le papillomavirus humain HPV16/18, en fonction du nombre de doses de vaccin reçues (1, 2 ou 3)
Cervical cancer elimination is defined by WHO as reducing and maintaining the incidence of cervical cancer to less than four in 100 000 women. 1 , 2 Although this rate was reached in Finland in 1990–95 with an organised annual cytology screening system, it could not be maintained. 3 Science and technology has evolved substantially from a test relying on cellular morphology to a precision medicine approach, with human papillomavirus (HPV) vaccination targeted to the most aggressive HPV types and primary HPV testing with biomarker triage. An understanding of which vaccine and how many doses to administer, as well as which primary HPV test and biomarkers to use for triage, are the remaining crucial questions, especially for communities with few resources. Recent evidence has produced clinical management risk thresholds for cervical intraepithelial neoplasia grade 3 or worse (CIN3+), which call for immediate treatment above the highest threshold and lesser thresholds for reassurance and extended surveillance. 4 , 5 The risk-based framework allows new technology to evolve within a standardised clinical guideline for management, bringing more precision, and thus efficiency, to global cervical cancer prevention.
The Lancet Oncology , commentaire, 2020