Background: In the context of the World Health Organization's (WHO) 90-70-90 targets for accelerating cervical cancer elimination, we aimed to assess the impact of achieving these targets and altering intervention factors on cervical cancer elimination in China and their potential benefits from preventing other human papillomavirus (HPV)-related cancers.
Methods: We developed a sexual contact network-Markov model to simulate HPV transmission and the progression of HPV-related cancers (cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers). We projected the population impact of achieving 90-70-90 targets by 2030 on the overall HPV-related cancer burden in China during 2024-2100. Sensitivity analyses were conducted to determine ranges for the projected results, and scenario analyses were conducted to quantify the impact of various intervention factors.
Findings: Maintaining the status quo would result in 8.72 (range 8.32-9.19) million cervical cancer cases and 944,100 (901,900-988,300) other HPV-related cancer cases from 2024 to 2100. Achieving 90-70-90 targets (with 2vHPV/4vHPV vaccines), scenario 1, would reduce cervical cancer incidence to <4 cases/100,000 women by 2093 (2085-∞), averting 3.57 (2.97-3.98) million cases. Switching to the 9vHPV vaccine from 2025, scenario 2, would advance elimination by 2088 (2078-∞), averting 3.65 (3.07-4.08) million cases. Scenarios 1 or 2 would prevent 168,600 (160,500-176,800) and 173,600 (165,400-184,300) other HPV-related cancers respectively by 2100. Increasing screening frequency from twice-per-lifetime recommendation to 5-yearly or 3-yearly screening moved elimination to 2061 or 2051 respectively. In scenario 1, achieving elimination before 2100 would be challenged if screening or vaccination coverage remains below 60% and 90% or if the time to reach 90% vaccination exceeds 2040 or if screening frequency or test sensitivity are substandard. Switching to the 9vHPV vaccine increased tolerance for these thresholds.
Interpretation: Based on our prediction model, achieving WHO's 90-70-90 targets in China could eliminate cervical cancer by the century's end and help prevent other HPV-related cancers. Enhanced screening frequency and adoption of the 9vHPV vaccine are critical for accelerating elimination efforts.
Funding: National Natural Science Foundation of China (82304206 and 81950410639).
Keywords: Cervical cancer; Elimination; HPV-related cancer; Human papillomavirus vaccination; Model projection; Screening.
© 2024 The Authors.