HPV vaccination and the long game on cervical cancer

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The human papilloma virus vaccine is, at its core, a cancer prevention vaccine. HPV causes cervical cancer, pharyngeal cancer (especially in boys), probably oesophageal cancer, and anal cancer. The question that has hung over the program since its introduction has always been durability: how long does the protection actually last?

A large Swedish study of over 900,000 women, many followed for 18 years, now provides a clear answer. There was no reduction in cancer protection over that time. The greatest benefit was seen in girls vaccinated under the age of 17, presumably because they were less likely to have been exposed to HPV through sexual contact before vaccination.

Self-collected cervical samples were more likely to detect HPV infection and proved popular with underserved groups who avoid traditional screening.

The second study shifts focus to screening, specifically the uptake and reliability of self-collection of cervical samples, which is increasingly becoming standard practice. One of the persistent problems with cervical cancer screening has been reach. Women living in disadvantage, in remote and rural areas, and older women have historically been under-screened because they find the traditional screening process uncomfortable or culturally inappropriate.

Australian researchers investigated whether self-collection could close that gap. It did. Self-collection proved popular particularly among these underserved groups, significantly extending screening reach across populations that had previously fallen through the cracks. Critically, the self-collected samples were, if anything, more likely to detect HPV infection than practitioner-collected samples, making it not just more accessible but more effective.

Australia has set itself the goal of eliminating cervical cancer. It is a particularly aggressive malignancy, and elimination is an ambitious target. But with an HPV vaccine that holds its protection for nearly two decades and a screening method that reaches women who were previously unreachable, the pathway is clearer than it has ever been.