The Role of Implementing an HPV Vaccination Program with Optimizing Cervical Cancer Screening and Treatment as an Ambitious Strategy to Reduce Cervical Cancer Prevalence in Developing Countries: A Literature Review
DOI:
https://doi.org/10.53366/jimki.v11i3.780Keywords:
Cervical cancer [MeSH], Cervical cancer screening, Cervical cancer treatment, HPV vaccineAbstract
Background: Cervical cancer is the fourth most common type of cancer in women in the world, with 94% of total deaths worldwide occurring in developing countries in 2022. In response to this problem, WHO initiated a movement to eliminate cervical cancer, known as the 90-90 strategy, through implementing vaccination programs and optimizing screening and treatment for cervical cancer cases. This literature review aims to describe the role of these strategies in eliminating cervical cancer, especially in developing countries.
Methods: Literature was searched using search sites such as Google Scholar, Science Direct, ResearchGate, and NCBI. Inclusion and exclusion criteria were used to eliminate unrelated literature to obtain 36 literature.
Discussion: HPV vaccination has been proven to provide protective benefits in reducing the incidence of neoplastic lesions and shows a relatively decreasing trend in the group receiving the vaccine. Cervical screening plays a very important role in the early detection and therapy of precancer, which shows a trend in preventing cancer cases in the next 50 years. Modeling studies show that successful implementation of the WHO 90-70-90 intervention by 2030 will reduce the incidence of cervical cancer to 0.7 per 100,000 women and the death rate to 0.2 per 100,000 women in all developing countries.
Conclusion: The implementation of the HPV vaccination program with the optimization of cervical cancer screening and treatment is believed to be a solution modality to reduce morbidity and mortality rates due to cervical cancer in the world, especially in developing countries.
References
1. Cervical cancer [Internet]. World Health Organization; [cited 2024 May 23]. Available from: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
2. Zhang S, Xu H, Zhang L, Qiao Y. Cervical cancer: Epidemiology, Risk Factors and Screening. Chinese Journal of Cancer Research [Internet]. 2020 Dec 31;32(6):720–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797226/
3. Lei J, Ploner A, Elfström KM, Wang J, Roth A, Fang F, et al. HPV Vaccination and the Risk of Invasive Cervical Cancer. New England Journal of Medicine [Internet]. 2020 Oct 1;383(14):1340–8. Available from: https://pubmed.ncbi.nlm.nih.gov/32997908/
4. Hall M, Simms KT, Murray JM, Keane A, Nguyen D, Caruana M, et al. Benefits and harms of cervical screening, triage and treatment strategies in women living with HIV. Nature Medicine. 2023 Dec 1;29(12):3059–66.
5. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209?249.
6. Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri: 2021 update. Int J Gynaecol Obstet. 2021 Oct;155 Suppl 1(Suppl 1):28-44. doi: 10.1002/ijgo.13865. PMID: 34669203; PMCID: PMC9298213.
7. Stelzle D, Tanaka LF, Lee KK, Khalil AI, Baussano I, Shah AS, McAllister DA, Gottlieb SL, Klug SJ, Winkler AS, Bray F. Estimates of the global burden of cervical cancer associated with HIV. The Lancet global health. 2021 Feb 1;9(2):e161-9.
8. Svidler López L, La Rosa L. Human Papilloma Virus Infection and Anal Squamous Intraepithelial Lesions. Clinics in Colon and Rectal Surgery. 2019 Aug 22;32(05):347–57.
9. Oyouni AAA. Human papillomavirus in cancer: Infection, disease transmission, and progress in vaccines. Journal of Infection and Public Health. 2023 Apr;16(4):626–31.
10. Wei E, Li J, Anand P, French LE, Wattad A, Clanner-Engelshofen B, et al. “From molecular to clinic”: The pivotal role of CDC42 in pathophysiology of human papilloma virus related cancers and a correlated sensitivity of afatinib. Frontiers in Immunology. 2023 Mar 1;14.
11. Balasubramaniam SD, Balakrishnan V, Oon CE, Kaur G. Key Molecular Events in Cervical Cancer Development. Medicina [Internet]. 2019 Jul 17;55(7):384. Available From:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681523/pdf/medicina-55-00384.pdf
12. Mandigo AC, Tomlins SA, Kelly WK, Knudsen KE. Relevance of pRB Loss in Human Malignancies. Clinical Cancer Research. 2021 Aug 18;clincanres.1565.2021.
13. Soheili M, Keyvani H, Soheili M, Nasseri S. Human papilloma virus: A review study of epidemiology, carcinogenesis, diagnostic methods, and treatment of all HPV-related cancers. Medical Journal of The Islamic Republic of Iran. 2021 Apr 30;35.
14. Miyauchi S, Kim SS, Jones RN, Zhang L, Kripa Guram, Sharma S, et al. Human papillomavirus E5 suppresses immunity via inhibition of the immunoproteasome and STING pathway. Cell Reports. 2023 May 1;42(5):112508–8.
15. Swid MA, Monaco SE. Should screening for cervical cancer go to primary human papillomavirus testing and eliminate cytology? Modern Pathology. 2022 Mar 7;35(7):858–64.
16. Bouvard V, Wentzensen N, Mackie A, Berkhof J, Brotherton J, Giorgi-Rossi P, et al. The IARC Perspective on Cervical Cancer Screening. New England Journal of Medicine [Internet]. 2021 Nov 11;385(20):1908–18. Available from: https://iarc.who.int/wp-content/uploads/2021/11/pr305_E.pdf
17. Bedell SL, Goldstein LS, Goldstein AR, Goldstein AT. Cervical Cancer Screening: Past, Present, and Future. Sexual Medicine Reviews [Internet]. 2020 Jan 1;8(1):28–37. Available from: https://pubmed.ncbi.nlm.nih.gov/31791846/
18. Ferrall L, Lin KY, Roden RBS, Hung CF, Wu TC . Cervical Cancer Immunotherapy: Facts and Hopes. Clinical Cancer Research. 2021 Apr 22;27(18).
19. Serkies K, Jassem J. Systemic therapy for cervical carcinoma - current status. Chin J Cancer Res 2018;30(2):209–21 doi 10.21147/j.issn.1000-9604.2018.02.04.
20. Achouri A, Huchon C, Bats AS, Bensaid C, Nos C, Lécuru F. Complications of lymphadenectomy for gynecologic cancer. Eur J Surg Oncol. 2013;39:81–6.
21. Aoun F, Roumeguère T. Les Conséquences neuro-urologiques de la colpohystérectomie totale pour le traitement du cancer du col utérin [Lower urinary tract dysfunction following radical hysterectomy]. Prog Urol (2015) 25:1184–90. doi: 10.1016/j.purol.2015.08.311
22. Tsai TY, Chen SY, Tsai MH, Su YL, Ho CM, Su HF. Prevalence and associated factors of sexual dysfunction in cervical cancer patients. J Sex Med (2011) 8:1789–96. doi: 10.1111/j.1743-6109.2010.01745.x
23. Rosenberg SA, Restifo NP. Adoptive cell transfer as personalized immunotherapy for human cancer. Science 2015;348(6230):62–8 doi 10.1126/science.aaa4967.
24. Zsiros E, Tsuji T, Odunsi K. Adoptive T-cell therapy is a promising salvage approach for advanced or recurrent metastatic cervical cancer. J Clin Oncol 2015;33(14):1521–2 doi 10.1200/jco.2014.60.6566.
25. Zhang E, Dai Z, Wang S, Wang X, Zhang X, Fang Q. Vaccine Literacy and Vaccination: A Systematic Review. International Journal of Public Health [Internet]. 2023;68:1605606. Available from: https://pubmed.ncbi.nlm.nih.gov/36866001/
26. Zhang X, Wang Z, Ren Z, Li Z, Ma W, Gao X, et al. HPV vaccine acceptability and willingness-related factors among Chinese adolescents: a nation-wide study. Human Vaccines & Immunotherapeutics. 2020 Oct 29;1–8.
27. Pattyn J, Van Keer S, Tjalma W, Matheeussen V, Van Damme P, Vorsters A. Infection and vaccine-induced HPV-specific antibodies in cervicovaginal secretions. A review of the literature. Papillomavirus Research. 2019 Dec;8:100185.
28. Soca Gallego L, Dominguez A, Parmar M. Human Papilloma Virus Vaccine [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562186/
29. Athanasiou A, Bowden S, Paraskevaidi M, Fotopoulou C, Martin-Hirsch P, Paraskevaidis E, et al. HPV vaccination and cancer prevention. Best Practice & Research Clinical Obstetrics & Gynaecology. 2020 May;65:109–24.
30. Emi Naslazi, Jan A.C. Hontelez, Naber SK, Marjolein van Ballegooijen, M.C.M I. The Differential Risk of Cervical Cancer in HPV-Vaccinated and -Unvaccinated Women: A Mathematical Modeling Study. Cancer Epidemiology, Biomarkers & Prevention [Internet]. 2021 Apr 9 [cited 2024 Feb 20];30(5):912–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102319/
31. SIGNORELLI C, ODONE A, CIORBA V, CELLA P, AUDISIO RA, LOMBARDI A, et al. Human papillomavirus 9-valent vaccine for cancer prevention: a systematic review of the available evidence. Epidemiology and Infection [Internet]. 2017 Apr 27;145(10):1962–82. Available from: https://www.cambridge.org/core/services/aop-cambridge-core/content/view/08CBB257EF6FE668C7280818AC2C6FD6/S0950268817000747a.pdf/human_papillomavirus_9valent_vaccine_for_cancer_prevention_a_systematic_review_of_the_available_evidence.pdf
32. Pei J, Shu T, Wu C, Li M, Xu M, Jiang M, et al. Impact of human papillomavirus vaccine on cervical cancer epidemic: Evidence from the surveillance, epidemiology, and end results program. Frontiers in Public Health [Internet]. 2023 Jan 6;10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9859059/
33. Canfell K, Kim JJ, Brisson M, Keane A, Simms KT, Caruana M, et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. The Lancet. 2020 Feb;395(10224):591–603.
34. Ferrara P, Agüero F, Masuet-Aumatell C, Ramon-Torrell JM. Burden of cancer mortality attributable to carcinogenic infections in Spain. Medicina Clínica. 2020 May;154(10):394–7.
35. Landy R, Sasieni PD, Mathews C, Wiggins CL, Robertson M, McDonald YJ, et al. Impact of screening on cervical cancer incidence: A population?based case–control study in the United States. International Journal of Cancer. 2019 Dec 31;147(3):887–96.
36. Simms KT, Steinberg J, Caruana M, Smith MA, Lew JB, Soerjomataram I, et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling study. The Lancet Oncology. 2019 Mar;20(3):394–407.
2. Zhang S, Xu H, Zhang L, Qiao Y. Cervical cancer: Epidemiology, Risk Factors and Screening. Chinese Journal of Cancer Research [Internet]. 2020 Dec 31;32(6):720–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797226/
3. Lei J, Ploner A, Elfström KM, Wang J, Roth A, Fang F, et al. HPV Vaccination and the Risk of Invasive Cervical Cancer. New England Journal of Medicine [Internet]. 2020 Oct 1;383(14):1340–8. Available from: https://pubmed.ncbi.nlm.nih.gov/32997908/
4. Hall M, Simms KT, Murray JM, Keane A, Nguyen D, Caruana M, et al. Benefits and harms of cervical screening, triage and treatment strategies in women living with HIV. Nature Medicine. 2023 Dec 1;29(12):3059–66.
5. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209?249.
6. Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri: 2021 update. Int J Gynaecol Obstet. 2021 Oct;155 Suppl 1(Suppl 1):28-44. doi: 10.1002/ijgo.13865. PMID: 34669203; PMCID: PMC9298213.
7. Stelzle D, Tanaka LF, Lee KK, Khalil AI, Baussano I, Shah AS, McAllister DA, Gottlieb SL, Klug SJ, Winkler AS, Bray F. Estimates of the global burden of cervical cancer associated with HIV. The Lancet global health. 2021 Feb 1;9(2):e161-9.
8. Svidler López L, La Rosa L. Human Papilloma Virus Infection and Anal Squamous Intraepithelial Lesions. Clinics in Colon and Rectal Surgery. 2019 Aug 22;32(05):347–57.
9. Oyouni AAA. Human papillomavirus in cancer: Infection, disease transmission, and progress in vaccines. Journal of Infection and Public Health. 2023 Apr;16(4):626–31.
10. Wei E, Li J, Anand P, French LE, Wattad A, Clanner-Engelshofen B, et al. “From molecular to clinic”: The pivotal role of CDC42 in pathophysiology of human papilloma virus related cancers and a correlated sensitivity of afatinib. Frontiers in Immunology. 2023 Mar 1;14.
11. Balasubramaniam SD, Balakrishnan V, Oon CE, Kaur G. Key Molecular Events in Cervical Cancer Development. Medicina [Internet]. 2019 Jul 17;55(7):384. Available From:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681523/pdf/medicina-55-00384.pdf
12. Mandigo AC, Tomlins SA, Kelly WK, Knudsen KE. Relevance of pRB Loss in Human Malignancies. Clinical Cancer Research. 2021 Aug 18;clincanres.1565.2021.
13. Soheili M, Keyvani H, Soheili M, Nasseri S. Human papilloma virus: A review study of epidemiology, carcinogenesis, diagnostic methods, and treatment of all HPV-related cancers. Medical Journal of The Islamic Republic of Iran. 2021 Apr 30;35.
14. Miyauchi S, Kim SS, Jones RN, Zhang L, Kripa Guram, Sharma S, et al. Human papillomavirus E5 suppresses immunity via inhibition of the immunoproteasome and STING pathway. Cell Reports. 2023 May 1;42(5):112508–8.
15. Swid MA, Monaco SE. Should screening for cervical cancer go to primary human papillomavirus testing and eliminate cytology? Modern Pathology. 2022 Mar 7;35(7):858–64.
16. Bouvard V, Wentzensen N, Mackie A, Berkhof J, Brotherton J, Giorgi-Rossi P, et al. The IARC Perspective on Cervical Cancer Screening. New England Journal of Medicine [Internet]. 2021 Nov 11;385(20):1908–18. Available from: https://iarc.who.int/wp-content/uploads/2021/11/pr305_E.pdf
17. Bedell SL, Goldstein LS, Goldstein AR, Goldstein AT. Cervical Cancer Screening: Past, Present, and Future. Sexual Medicine Reviews [Internet]. 2020 Jan 1;8(1):28–37. Available from: https://pubmed.ncbi.nlm.nih.gov/31791846/
18. Ferrall L, Lin KY, Roden RBS, Hung CF, Wu TC . Cervical Cancer Immunotherapy: Facts and Hopes. Clinical Cancer Research. 2021 Apr 22;27(18).
19. Serkies K, Jassem J. Systemic therapy for cervical carcinoma - current status. Chin J Cancer Res 2018;30(2):209–21 doi 10.21147/j.issn.1000-9604.2018.02.04.
20. Achouri A, Huchon C, Bats AS, Bensaid C, Nos C, Lécuru F. Complications of lymphadenectomy for gynecologic cancer. Eur J Surg Oncol. 2013;39:81–6.
21. Aoun F, Roumeguère T. Les Conséquences neuro-urologiques de la colpohystérectomie totale pour le traitement du cancer du col utérin [Lower urinary tract dysfunction following radical hysterectomy]. Prog Urol (2015) 25:1184–90. doi: 10.1016/j.purol.2015.08.311
22. Tsai TY, Chen SY, Tsai MH, Su YL, Ho CM, Su HF. Prevalence and associated factors of sexual dysfunction in cervical cancer patients. J Sex Med (2011) 8:1789–96. doi: 10.1111/j.1743-6109.2010.01745.x
23. Rosenberg SA, Restifo NP. Adoptive cell transfer as personalized immunotherapy for human cancer. Science 2015;348(6230):62–8 doi 10.1126/science.aaa4967.
24. Zsiros E, Tsuji T, Odunsi K. Adoptive T-cell therapy is a promising salvage approach for advanced or recurrent metastatic cervical cancer. J Clin Oncol 2015;33(14):1521–2 doi 10.1200/jco.2014.60.6566.
25. Zhang E, Dai Z, Wang S, Wang X, Zhang X, Fang Q. Vaccine Literacy and Vaccination: A Systematic Review. International Journal of Public Health [Internet]. 2023;68:1605606. Available from: https://pubmed.ncbi.nlm.nih.gov/36866001/
26. Zhang X, Wang Z, Ren Z, Li Z, Ma W, Gao X, et al. HPV vaccine acceptability and willingness-related factors among Chinese adolescents: a nation-wide study. Human Vaccines & Immunotherapeutics. 2020 Oct 29;1–8.
27. Pattyn J, Van Keer S, Tjalma W, Matheeussen V, Van Damme P, Vorsters A. Infection and vaccine-induced HPV-specific antibodies in cervicovaginal secretions. A review of the literature. Papillomavirus Research. 2019 Dec;8:100185.
28. Soca Gallego L, Dominguez A, Parmar M. Human Papilloma Virus Vaccine [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562186/
29. Athanasiou A, Bowden S, Paraskevaidi M, Fotopoulou C, Martin-Hirsch P, Paraskevaidis E, et al. HPV vaccination and cancer prevention. Best Practice & Research Clinical Obstetrics & Gynaecology. 2020 May;65:109–24.
30. Emi Naslazi, Jan A.C. Hontelez, Naber SK, Marjolein van Ballegooijen, M.C.M I. The Differential Risk of Cervical Cancer in HPV-Vaccinated and -Unvaccinated Women: A Mathematical Modeling Study. Cancer Epidemiology, Biomarkers & Prevention [Internet]. 2021 Apr 9 [cited 2024 Feb 20];30(5):912–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102319/
31. SIGNORELLI C, ODONE A, CIORBA V, CELLA P, AUDISIO RA, LOMBARDI A, et al. Human papillomavirus 9-valent vaccine for cancer prevention: a systematic review of the available evidence. Epidemiology and Infection [Internet]. 2017 Apr 27;145(10):1962–82. Available from: https://www.cambridge.org/core/services/aop-cambridge-core/content/view/08CBB257EF6FE668C7280818AC2C6FD6/S0950268817000747a.pdf/human_papillomavirus_9valent_vaccine_for_cancer_prevention_a_systematic_review_of_the_available_evidence.pdf
32. Pei J, Shu T, Wu C, Li M, Xu M, Jiang M, et al. Impact of human papillomavirus vaccine on cervical cancer epidemic: Evidence from the surveillance, epidemiology, and end results program. Frontiers in Public Health [Internet]. 2023 Jan 6;10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9859059/
33. Canfell K, Kim JJ, Brisson M, Keane A, Simms KT, Caruana M, et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. The Lancet. 2020 Feb;395(10224):591–603.
34. Ferrara P, Agüero F, Masuet-Aumatell C, Ramon-Torrell JM. Burden of cancer mortality attributable to carcinogenic infections in Spain. Medicina Clínica. 2020 May;154(10):394–7.
35. Landy R, Sasieni PD, Mathews C, Wiggins CL, Robertson M, McDonald YJ, et al. Impact of screening on cervical cancer incidence: A population?based case–control study in the United States. International Journal of Cancer. 2019 Dec 31;147(3):887–96.
36. Simms KT, Steinberg J, Caruana M, Smith MA, Lew JB, Soerjomataram I, et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling study. The Lancet Oncology. 2019 Mar;20(3):394–407.
Additional Files
Published
2025-10-13
Issue
Section
Article Review
License
Copyright (c) 2025 Adinda Nezma Meidina, Yolanda Delia Putri, M. Aditya Nugraha, Muhammad Muhadzdzab Fadhlan, Nafilah Ramadhanti
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
The Role of Implementing an HPV Vaccination Program with Optimizing Cervical Cancer Screening and Treatment as an Ambitious Strategy to Reduce Cervical Cancer Prevalence in Developing Countries: A Literature Review. (2025). JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia, 11(3), 11-20. https://doi.org/10.53366/jimki.v11i3.780