Between 80 and 90% of the sexually active adult population has been in contact with the human papillomavirus (HPV), the most common sexually transmitted infection. In most cases, the infection resolves spontaneously due to the action of the immune system. However, in some cases, the infection persists and can cause precancerous lesions and finally cervical cancer. Also, VPH is responsible of the genital warts.
Nowadays, with the prevention tools that we have it is considered that cervical cancer caused by HPV is a cancer that could be eliminated. On November 17, 2020, the World Health Organization (WHO) launched the Campaign for the Elimination of this Cancer. This campaign exposed three goals: to vaccinate at least 90% of girls before the age of fifteen, minimum participation of 70% of women in screening at least twice in their lifetime, and for 90% of women diagnosed with precancerous lesions and cervical cancer access effective treatment.
In 2018, March 4 was established as International HPV Awareness Day. The commemoration is part of the International Papillomavirus Society’s commitment to increase global understanding of the virus. The theme of this year is “One Less Worry”. The goal is to empower people with the information needed to make informed decisions about their health.
An effective vaccine against cancer
HPV vaccines protects against the virus types that can cause cancers against the ones that cause anogenital warts. Clinical trials have for many years demonstrated their safety and efficacy in preventing infection, virus persistence, and precancerous lesions. “In addition, now we have the first data indicating their high efficacy in invasive cancer prevention. Vaccination stared 15 years ago, enough time to complete the natural cycle from infection to cancer and observe that vaccines prevent the precancerous lesions and the next step the invasive cancer”, says Dr Laia Alemany, head of the infection and cancer research group at IDIBELL and ICO.
So far, and following the WHO campaign for cervical cancer elimination, the HPV vaccine has been incorporated into the vaccination plan of half of the countries. Dr Alemany comments: “This represents a worldwide vaccination of 15% of girls under fifteen years, but we must keep in mind that in countries with a large population, such as India or China, the vaccine is still pending implementation“. In Catalonia, vaccination rates are very good and have already covered 80% of girls.
The recommendation regarding the number of doses has also been changing as more data have become available. Whereas initially, the recommendation was three doses at the age of 11-12 years, it has now been established that two doses are enough to achieve immunity. There are plans to reduce it to a single dose, a strategy that has just been approved in the United Kingdom, and which could facilitate the implementation of the vaccine throughout the world.
Improvements in screening
Until now, screning was carried out by cytology tests that checked for precancerous lesions due to HPV infection. In Catalonia, it is recommended start the screening at 25 years-old and maintain a regular test until 65 years-old.
“Much more sensitive molecular tests that directly detect the genetic material of the virus are now emerging making possible to detect more lesions and space out screening,” adds Dr Alemany, “in addition, this test identifies the type of HPV, what permits to start a close follow-up if the HPV is a high oncogenic risk type“.
The IDIBELL and ICO research group is conducting a pilot test with a self-collection device that allows the sample collection for molecular testing at home. For now, the population acceptance of this new device is being evaluated.
The Bellvitge Biomedical Research Institute (IDIBELL) is a biomedical research center created in 2004. It is participated by the Bellvitge University Hospital and the Viladecans Hospital of the Catalan Institute of Health, the Catalan Institute of Oncology, the University of Barcelona and the City Council of L’Hospitalet de Llobregat.
IDIBELL is a member of the Campus of International Excellence of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish research centers accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the “HR Excellence in Research” program of the European Union and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Center of the AECC Scientific Foundation (FCAECC).