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HPV-FASTER: broadening the scope for prevention of HPV-related cancer

Abstract

Human papillomavirus (HPV)-related screening technologies and HPV vaccination offer enormous potential for cancer prevention, notably prevention of cervical cancer. The effectiveness of these approaches is, however, suboptimal owing to limited implementation of screening programmes and restricted indications for HPV vaccination. Trials of HPV vaccination in women aged up to 55 years have shown almost 90% protection from cervical precancer caused by HPV16/18 among HPV16/18-DNA-negative women. We propose extending routine vaccination programmes to women of up to 30 years of age (and to the 45–50-year age groups in some settings), paired with at least one HPV-screening test at age 30 years or older. Expanding the indications for HPV vaccination and much greater use of HPV testing in screening programmes has the potential to accelerate the decline in cervical cancer incidence. Such a combined protocol would represent an attractive approach for many health-care systems, in particular, countries in Central and Eastern Europe, Latin America, Asia, and some more-developed parts of Africa. The role of vaccination in women aged >30 years and the optimal number of HPV-screening tests required in vaccinated women remain important research issues. Cost-effectiveness models will help determine the optimal combination of HPV vaccination and screening in public health programmes, and to estimate the effects of such approaches in different populations.

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Figure 1: The HPV-FASTER core concept and the rationale for combined HPV screening and vaccination of women up to 45–50 years of age.
Figure 2: Framework of cervical cancer preventive strategies and of the HPV-FASTER strategy.
Figure 3: Modelling the effects of increasing the number of age cohorts vaccinated against HPV16/18 on time to reduction in the prevalence of HPV infection.

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Acknowledgements

The authors are grateful for the work of all the collaborators and personnel involved in the HPV European Consortium. The work of the authors was partially supported by the European Union Seventh Framework Programme (grant agreement #603019; CoheaHr) to all authors except S.M.G. and J.S.; the Spanish Ministry of Economy and Competitiveness via the Instituto de Salud Carlos III (RD12/0036/0056 and CIBERESP) to F.X.B., C.R., M.D., X.C., L.B. and S.d.S.; the Government of Catalonia via the Agència de Gestió d'Ajuts Universitaris i de Recerca (Agency for Management of University and Research Grant 2014SGR1077 and 2014SGR2016 to F.X.B., C.R., M.D., X.C., L.B. and S.d.S.); the Lilly Foundation (Premio de Investigación Biomédica Preclínica 2012 to F.X.B.); the National Institute of Public Health and the Environment (Bilthoven, Netherlands) to M.A.; the German Guideline Program in Oncology (German Cancer Aid project #110163 to M.A.); the Belgian Health Care Knowledge Centre (Brussels, Belgium) to M.A.; the Bill and Melinda Gates Foundation (OPP1053353 to I.B.); the Institut National du Cancer to C.C.; Zorgonderzoek Nederland-Medische Wetenschappen (ZON-MW) and the Dutch Cancer Society to C.J.L.M.M.; and Cancer Research UK (C569/A16891 to J.C.).

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F.X.B., C.R., M.D., M.A., I.B. and J.C. researched the data for article and wrote the manuscript. All authors made substantial contributions to discussion of content and reviewed/edited the manuscript before submission.

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Correspondence to F. Xavier Bosch.

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Competing interests

F.X.B., C.R., M.D., X.C., L.B. and S.d.S. have received research funding via their institution from Genticel, GlaxoSmithKline, Merck, Qiagen, Roche, and Sanofi Pasteur MSD. F.X.B. has received reimbursement of travel expenses for attending symposia, meeting and/or conferences from GlaxoSmithKline, Merck, Qiagen, Roche, and Sanofi Pasteur MSD. C.C. has received reimbursement of travel expenses for attending symposia, meeting and/or conferences from Hologic, Roche, and Sanofi Pasteur MSD; and honoraria as a scientific advisory board member from Roche and Sanofi Pasteur MSD. J.D. has received research funding via his institution from Merck and Sanofi Pasteur MSD. K.-U.P. has received research funding via his institution from Sanofi Pasteur MSD; has been an consultant for Becton Dickinson, Roche Diagnostics, and Sanofi Pasteur MSD; and has receiving speakers' honoraria from Becton Dickinson, GlaxoSmithKline, and Roche. M.P. has received reimbursement of travel expenses for attending symposia, meeting and/or conferences, and honoraria for speaking and consultancy from Abbott. S.K.K. has received research funding via her institution, and honorarium as a scientific advisory board member and speaker from Merck and Sanofi Pasteur MSD. C.J.L.M.M. has received research funding from Abbott and Gen-Probe; has minority stock of Diassay and Self-Screen, a spin-off company of the Vrije Universiteit Medical Centre; has held shares in Delphi Biosciences, a former producer of a lavage self-sampling device for cervical cancer screening until 2014, when it went into receivership; has received honoraria from Genticel and Qiagen; has received honoraria occasionally as a scientific advisory board member or for serving at the speakers bureau of GlaxoSmithKline, Qiagen, Roche, and Sanofi Pasteur MSD/Merck; has received honoraria as speaker from Menarini and Seegene; and has received research funding via his institution from GlaxoSmithKline and Sanofi Pasteur MSD. S.M.G. has received research funding via her institution from CSL Bio, GlaxoSmithKline, and Merck; and is a member of the Merck Global Advisory Board and the Merck Scientific Advisory Committee for HPV (unpaid position). X.C. has received reimbursement of travel expenses for attending symposia, meeting and/or conferences from Genticel, GlaxoSmithKline, Merck, Sanofi Pasteur MSD, and Vianex. S.d.S. has received reimbursement of travel expenses for attending symposia, meeting and/or conferences from GlaxoSmithKline, Qiagen, and Sanofi Pasteur MSD. J.C. has received research funding via his institution from Abbott, Beckton Dickinson, Cepheid, Genera, Hologic, Qiagen, and Trovagene; honoraria from Hologic Cepheid, and Merck; and has been on sponsored speakers bureau for Trovagene. M.A., I.B., G.R., M.L. and J.S. declare no competing interests.

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Bosch, F., Robles, C., Díaz, M. et al. HPV-FASTER: broadening the scope for prevention of HPV-related cancer. Nat Rev Clin Oncol 13, 119–132 (2016). https://doi.org/10.1038/nrclinonc.2015.146

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