Into the archives: the story of HPV and cervical cancer

Cancer Research UK – Nov 21st 2022

“It’s a huge achievement by lots and lots of people. It’s nice to think that this next generation will probably never really have to worry about cervical cancer in this country.”

Last year, a monumental moment on a cold November day saw the publication of a long-awaited study.

The results of that study, published in the Lancet, and carried out by our researchers, found that the human papillomavirus (HPV) vaccine was shown to dramatically reduce cervical cancer rates by almost 90% in women in their 20s who were offered it at ages 12 to 13.

This year, to celebrate 20 years of Cancer Research UK and 120 years of lifesaving research, we’ve been looking back in time and digging into the archives to explore some of the impact we’ve had in cancer research.

From helping to strengthen the understanding of the link between HPV and cervical cancer, to working towards reducing cervical cancer to the point where almost no one develops it, our history with this particular disease goes way back.

Full Read – Into the archives: the story of HPV and cervical cancer

Background research – The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study

New insights on self-sampling for cervical cancer screening

Drysdale, H. et al. (2022). Self-sampling for cervical screening offered at the point of invitation: A cross-sectional study of preferences in England. Journal of Medical Screening. https://doi.org/10.1177/09691413221092246

A study funded by Cancer Research UK has published the results of its qualitative study which assessed intentions (motivational stage) to provide an upper estimate of how many women might select self-sampling over clinician screening if they were offered a choice. The research team also examined associations between demographic factors and past screening behaviours and preferences for self-sampling, as well as reasons for women’s choices.

Abstract

Objectives

This study assessed preferences for human papillomavirus (HPV) self-sampling if offered as an alternative to clinician-based screening at the point of invitation for cervical screening.

Setting and Methods

An online questionnaire was completed by screening-eligible women living in England (n equal to  3672). Logistic regressions explored associations between demographic characteristics and screening preferences, stratified by previous screening attendance. Reasons for preferences were also assessed.

Results

Half of participants (51.4 per cent) intended to choose self-sampling, 36.5 per cent preferred clinician screening, 10.5 per cent were unsure, and less than 2 per cent preferred no screening. More irregular and never attenders chose self-sampling, compared with regular attenders (71.1 per cent and 70.1 per cent vs. 41.0 per cent respectively). Among regular attenders, self-sampling was preferred more frequently by the highest occupational grade, older and lesbian, gay and bisexual women, and those with experience of blood self-tests. In the irregular attender group, older women and those with experience of blood self-tests were more likely to choose self-sampling. In ‘never attenders’, self-sampling was less popular in ethnic minority groups.

Conclusions

If offered a choice of screening, around half of women in England may choose self-sampling, but a substantial proportion would still opt for clinician screening. Screening providers will need to manage a high take-up of self-sampling if many regular attenders switch to self-sampling.

Cancer Research UK New insights on self-sampling for cervical cancer screening

Self-sampling for cervical screening offered at the point of invitation: A cross-sectional study of preferences in England [paper]

HPV vaccine sees cervical cancer rates cut by almost 90 per cent in women who had it, new study shows

via Sky News | 4 November 2021 | HPV vaccine sees cervical cancer rates cut by almost 90 per cent in women who had it, new study shows

Cervical cancer rates are almost 90 per cent lower in women vaccinated against HPV, a new study has found.

Women offered the vaccine between the ages of 12 and 13 were found to have cancer rates 87 per cent lower than in previous generations, according to a study published in The Lancet.

Researchers also found a reduction of 62 per cent in women vaccinated between ages 14 and 16.

The first generation of women, who were offered “catch-up” jabs aged between 16 and 18, were found to have a 34 per cent reduction in cervical cancer rates.

Professor Peter Sasieni, from King’s College London and one of the authors of the paper, told Sky News some of the results were “almost too good to be true”. (Source: Sky News)

Full news story available in full from Sky News

In the news:

BBC News HPV vaccine cutting cervical cancer by nearly 90%

Be Clear on Cancer: first national ‘Cervical Screening Saves Lives’ campaign

Public Health England | July 2021 | Be Clear on Cancer: first national ‘Cervical Screening Saves Lives’ campaign

This online publication evaluates the first national ‘Cervical Screening Saves Lives’ campaign which ran in 2019 from 5 March 2019 to 30 April 2019 in England, as part of the wider Be Clear on Cancer initiative.

Full details from Public Health England

Cervical cancer could be eliminated says NHS England

Hundreds of lives will be spared every year in England thanks to a more sensitive cervical screening test rolled out as part of the NHS Long Term Plan | via NHS England

NHS experts said that there is “potential” to eliminate cervical cancer completely thanks to the change in primary test within the NHS Cervical Cancer Screening Programme, combined with the effectiveness of the HPV vaccine.

The new and more sensitive test now looks for traces of high risk Human Papillomavirus (HPV), which causes nearly all cases of cervical cancer. Any tests that are HPV positive are then checked for abnormal changes of the cervix.

HPV is a group of viruses with more than 100 types, but 14 types can cause cervical cancer as well as some head and neck cancers. It means that any sign of infection will be spotted at an earlier stage before it could potentially develop into cancer.

Since the beginning of December, every part of the country has had the new way of screening in place. There are 2,500 new cases of cervical cancer in England every year but research says that a quarter of those could be prevented with this new way of testing.

The introduction is part of the NHS Long Term Plan’s ambitions to catch tens of thousands more cancers earlier, when it is easier to treat and the chance of survival is higher.

Full detail “Potential to eliminate” cervical cancer in England thanks to NHS Long Term Plan  | NHS England

BMJ: Cancer screening uptake- only a third of women take up offers

Torjesen, I. | 2019| Cancer screening: only a third of women in England take up all offers | BMJ| 366 | l5588 | doi: https://doi.org/10.1136/bmj.l5588

A new study published in the BMJ indicates that of the screening services offered to women in their 60s, which include cervical, breast and bowel screening only a third attend these screening sessions.  

The study included over 3000 women aged between 60-65 who had responded to their last invitations from each of these three screening programmes.

Results showed that:

• 35% took part in all three screening programmes;
• 37% participated in two programmes;
• 17% accessed one type of screening; and
• 10% were not screened at all.

They found that in the last screening round, 2525 (83%) had taken up mammography, 1908 (62%) cervical screening, and 1635 (53%) bowel cancer screening, which is consistent with the proportions reported in the official statistics for England (78%, 58-59%, and 57-59%, respectively).

The researchers also explored area level correlations between participation in the three screening programmes and various population characteristics for all English general practices with complete data in the Fingertips database curated by Public Health England. This database reports health related data for England aggregated by administrative area.

General practices with higher proportions of unemployed patients and smokers had a lower rate of take-up of all three screening programmes. Conversely, general practices from areas with less deprivation, with more patients who are carers or have chronic illnesses themselves, and with more patients satisfied with the provided service were significantly more likely to attain high coverage rates in all programmes (Source:  Torjesen, 2019).

Abstract

Objectives

To determine how many women participate in all three recommended cancer screening programmes (breast, cervical, and bowel). During their early 60s, English women receive an invitation from all the three programmes.

Methods

For 3060 women aged 60–65 included in an England-wide breast screening case–control study, we investigated the number of screening programmes they participated in during the last invitation round. Additionally, using the Fingertips database curated by Public Health England, we explored area-level correlations between participation in the three cancer screening programmes and various population characteristics for all 7014 English general practices with complete data.
Results

Of the 3060 women, 1086 (35%) participated in all three programmes, 1142 (37%) in two, 526 (17%) in one, and 306 (10%) in none. Participation in all three did not appear to be a random event (p  less than 0.001). General practices from areas with less deprivation, with more patients who are carers or have chronic illnesses themselves, and with more patients satisfied with the provided service were significantly more likely to attain high coverage rates in all programmes.

Conclusions

Only a minority of English women is concurrently protected through all recommended cancer screening programmes. Future studies should consider why most women participate in some but not all recommended screening.

 

See also: King’s College London Only a third of women take up all offered cancer screenings, new research finds

BMJ Cancer screening: only a third of women in England take up all offers

Cervical Cancer statistics

Statistics from Cancer Research UK show that in 2015 there were around 2,500 new cases, and nearly 700 deaths attributable to cervical cancer, in England. The overall age standardised incidence rate has been declining since the 1990s, however incidence is increasing in younger women.

Cervical cancer is 99.8% preventable through the cervical screening and the human papilloma virus (HPV) vaccination programmes. A cervical screen collects cells from the cervix to be tested for abnormalities. In 2019, primary HPV testing will also be introduced as part of the screening process.

Most cases of cervical cancer are linked to HPV and the vaccine, currently offered by the NHS for free to girls aged 12 and 13 in UK schools, protects against the most of the virus strains responsible. The national HPV vaccination programme has successfully reduced infections of HPV type 16/18 in 16-21 year old women by 80%.

Full detail at Cancer Research UK

Campaigns

• PHE has just launched a campaign “Cervical Screening Save Lives” to improve uptake of screening.
• “Cervical Screening Awareness Week” will be held in June 2019, run by Jo’s Cervical Cancer Trust

Cervical screening coverage rates in England fall

This report presents information about the NHS Cervical Screening Programme in England in 2016-17. It includes data on the call and recall system, on screening samples examined by pathology laboratories and on referrals to colposcopy clinics | NHS Digital

Key Facts:

• At 31 March 2017, the percentage of eligible women (aged 25 to 64) who were recorded as screened adequately within the specified period was 72.0 per cent. This compares with 72.7 per cent at 31 March 2016 and 75.4 per cent at 31 March 2012.

• A total of 4.45 million women aged 25 to 64 were invited for screening in 2016-17, representing an increase of 5.6 per cent from 2015-16 when 4.21 million women were invited.

• In total, 3.18 million women aged 25 to 64 years were tested in 2016-17, an increase of 2.9 per cent from 2015-16 when 3.09 million women were tested.

• Of samples submitted by GPs and NHS Community Clinics, 94.8 per cent of test results were returned Negative.

• 8.8 per cent of patients did not attend colposcopy appointments and gave no prior warning.

Full detail at NHS Digital: Cervical Screening Programme, England – 2016-17

Making cervical screening more accessible

Attendance for cervical screening has been falling year on year. This professional resource from Public Health England aims to address this decline in attendance by presenting recommendations that can help increase access to screening and awareness of cervical cancer.

Image source: http://www.gov.uk

Download the infographics, references and a shorter version of this publication here

Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women

Concurrent chemoradiotherapy (CCRT) is the standard treatment for local advanced cervical cancer. However, for elderly patients, studies are limited and the outcomes are controversial | BMC Cancer

Methods: We retrospectively analyzed the elderly cervical cancer patients treated with radical RT or CCRT between January 2006 and December 2014. For external beam radiotherapy, 50Gy in 25 fractions or 50.4Gy in 28 fractions were delivered via 3-dimensional conformal radiation therapy or intensity modulated radiation therapy. High-dose-rate intracavitary brachytherapy was performed with a dose of 30-36Gy in 5–7 fractions to point A. Concurrent chemotherapy regimens included weekly cisplatin and paclitaxel.

Conclusion: Elderly cervical cancer patients could tolerate radical RT and CCRT very well and get a favored survival. Compared with RT, CCRT could improve the survival of elder cervical cancer patients with similar nonhematological toxicity. CCRT should be considered in elderly cervical cancer patients.

Full reference: Wang, W. et al. (2017) Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women. BMC Cancer 17:510