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      Effectiveness of catch‐up and routine program of the 9‐valent vaccine on cervical cancer risk reduction in Japan

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          Abstract

          In 2013, the national human papillomavirus (HPV) immunization program began. However, in June 2013, Japan's Ministry of Health, Labor and Welfare (MHLW) announced a “temporary” suspension of its recommendation for the human papillomavirus vaccine. Finally, in November 2021, the MHLW ended its suspension of the recommendation of the HPV vaccine. To address the 9‐year gap in HPV vaccinations the suspension had caused, the MHLW conducted a program of catch‐up vaccinations from April 2022 to March 2025. Finally, in April 2023, the 9‐valent HPV vaccine was approved for both the routine and catch‐up vaccination programs in Japan. In this study, we investigated the potential effects of the introduction of the 9‐valent vaccine on the increased risk of cervical cancer in females born after fiscal year (FY) 2000. We estimated the lifetime relative risk of cervical cancer incidence and death using the improved routine and catch‐up vaccination rates after the recent resumption of the governmental recommendation for women and girls to have the HPV vaccination. These relative risks were calculated using a lifetime risk of 1.000 for cervical cancer incidence and death for females born in FY 1993. We predicted that even if a 90% vaccination rate were to be achieved by FY 2024 with the 9‐valent vaccine among women born between FY 2000 and FY 2005, the risk would remain higher than for the vaccination generation. Therefore, for women born between FY 2000 and FY 2005, it will be necessary to significantly improve the cervical cancer screening rate to compensate for this increased risk.

          Abstract

          In this study, we investigated the potential effects of the introduction of the 9‐valent vaccine on the increased risk of cervical cancer in females born after fiscal year (FY) 2000. We predicted that even if a 90% vaccination rate were to be achieved by FY2024 with the 9‐valent vaccine among women born between FY 2000 and FY 2005, the risk would remain higher than for the vaccination generation. Therefore, for women born between FY 2000 and FY 2005, it will be necessary to significantly improve the cervical cancer screening rate to compensate for this increased risk.

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          Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

          This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.
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            Impact of HPV vaccine hesitancy on cervical cancer in Japan: a modelling study

            Funding for human papillomavirus (HPV) vaccination in Japan began in 2010 for girls aged 12-16 years, with three-dose coverage initially reaching more than 70%. On June 14, 2013, 2 months after formal inclusion in Japan's national immunisation programme, proactive recommendations for the HPV vaccine were suspended following reports of adverse events since found to be unrelated to vaccination, but which were extensively covered in the media. Vaccine coverage subsequently dropped to less than 1% and has remained this low to date. We aimed to quantify the impact of this vaccine hesitancy crisis, and the potential health gains if coverage can be restored.
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              Real-world Effectiveness of Human Papillomavirus Vaccination Against Cervical Cancer

              Background The primary goal of human papillomavirus (HPV) vaccination is to reduce morbidity and mortality from HPV-associated disease, especially cervical cancer. We determined the real-world effectiveness of HPV vaccination against cervical cancer. Methods The study included women 17–30 years living in Denmark October 2006–December 2019. From nationwide registries, information on HPV vaccination and cervical cancer diagnoses were retrieved. Incidence rate ratios (IRRs) with 95% confidence intervals (CI) for cervical cancer according to vaccination status were estimated using Poisson regression with HPV vaccination treated as a time-varying variable and stratified by age at vaccination. We adjusted for attained age, education, and ethnicity. To address the effect of prevalent disease, different buffer periods were used, with one-year buffer period as primary analysis. Results The cohort comprised 867,689 women. At baseline, 36.3% were vaccinated at ≤ 16 years, and during follow-up, 19.3% and 2.3% were vaccinated at 17–19 and 20–30 years, respectively. For women vaccinated at ≤ 16 or 17–19 years, the IRRs of cervical cancer were 0.14 (95% CI:0. 04–0.53) and 0.32 (95% CI: 0.08–1.28), respectively, compared to unvaccinated women. In women 20–30 years at vaccination, the IR was higher than among unvaccinated women (IRR=1.19, 95% CI: 0.80–1.79), but slightly decreased with increasing buffer period (IRR=0.85 (95% CI: 0.55–1.32) with four-year buffer period). Conclusion HPV vaccine effectiveness against cervical cancer at the population-level is high among girls vaccinated before age 20 years. The lack of immediate effect in women vaccinated at age 20–30 years points to the importance of early age at vaccination.
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                Author and article information

                Contributors
                y.ueda@gyne.med.osaka-u.ac.jp
                Journal
                Cancer Sci
                Cancer Sci
                10.1111/(ISSN)1349-7006
                CAS
                Cancer Science
                John Wiley and Sons Inc. (Hoboken )
                1347-9032
                1349-7006
                30 December 2023
                March 2024
                : 115
                : 3 ( doiID: 10.1111/cas.v115.3 )
                : 916-925
                Affiliations
                [ 1 ] Department of Obstetrics and Gynecology Osaka University Graduate School of Medicine Osaka Japan
                [ 2 ] Department of Medical Statistics, Research and Development Center Osaka Medical and Pharmaceutical University Takatsuki Oita Japan
                [ 3 ] Department of Obstetrics and Gynecology Oita University Graduate School of Medicine Ufu Oita Japan
                [ 4 ] Faculty of Informatics Gunma University Maebashi Gunma Japan
                [ 5 ] Clinical Psychology, Graduate School of Human Sciences Osaka University Osaka Japan
                [ 6 ] Center for Public Health Sciences National Cancer Center Tokyo Japan
                Author notes
                [*] [* ] Correspondence

                Yutaka Ueda, Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2‐2, Yamadaoka, Suita, Osaka 565‐0871, Japan.

                Email: y.ueda@ 123456gyne.med.osaka-u.ac.jp

                Author information
                https://orcid.org/0000-0002-3222-5963
                https://orcid.org/0000-0001-7948-8990
                https://orcid.org/0000-0002-1407-2393
                https://orcid.org/0000-0002-3354-5096
                Article
                CAS16055 CAS-OA-2108-2023.R1
                10.1111/cas.16055
                10920980
                38158850
                ef78eef4-e14d-4295-8812-d7ecae9094e6
                © 2023 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 29 November 2023
                : 14 September 2023
                : 09 December 2023
                Page count
                Figures: 8, Tables: 1, Pages: 10, Words: 5542
                Funding
                Funded by: A Health and Labour Sciences Research Grant
                Award ID: 23EA1002
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                March 2024
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.9 mode:remove_FC converted:08.03.2024

                Oncology & Radiotherapy
                cervical cancer,health communication,hpv vaccine,japan,suspension of recommendation

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