Is elimination of cervical cancer in sight in England?

Objective: The age-standardised rate of cervical cancer is 8.5 per 100,000 in England, double the WHO "elimination" goal of 4.0 per 100,000, despite England being close to the target coverage for both HPV vaccination and cervical screening. Our aim was to see whether trends in mortality and incidence rates suggest that England is on the path to elimination.

Methods: We discuss trends in mortality rates since 1953 by birth cohort, and cancer and cancer-in-situ incidence rates since 2000 by age group in relation to screening and vaccination.

Results: Mortality trends suggest a steep decline in HPV prevalence from women born in the 1880s to those born in the 1930s followed by a continuing increase. Cancer incidence and mortality rates then fell steeply after the introduction of national screening in 1988. From 2004 women were invited for their first screen at age 25 rather than age 20, which was followed by a sharp increase in cancer-in-situ and invasive cancer rates at age 25-29. From 2015 to 2022 cervical cancer incidence then fell by 90 % below age 25 and by 80 % at age 25-29 following the introduction in 2008 of HPV vaccination at age 12-13 for girls born since 1995 with a catch-up for women born 1991-1994.

Conclusions: Vaccination alone may enable the NHS to reach its target for cervical cancer incidence of 4.0 per 100,000 by 2040. Whether switching from cytology to primary HPV testing in 2019 will reduce rates among unvaccinated women born before 1991 is not yet clear.