Rates of diagnoses and death set to rise in women not vaccinated against HPV, but likely to be almost eradicated in younger women, say researchers

Cervical cancer diagnoses and deaths in England are predicted to rise steeply among women over the age of 50 in the next two decades, even though deaths from the disease among the young who have been vaccinated are likely to be almost eradicated, according to a new study.

The HPV jab is radically changing the outlook for cervical cancer among women living in countries where it is routinely given to schoolgirls aged 12 or 13, before they become sexually active, and brings hope in the developing world of reducing the deaths where they are highest.

A study of the likely scenario up to 2040 in England, published in the journal Lancet Public Health, says cases are likely to drop by 75% among young women for whom vaccination is now the norm. Deaths from cervical cancer among the generation who were 17 or younger when the programme was introduced in 2008 will virtually disappear.

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But there are continuing problems for older women who have never been vaccinated against the human papilloma virus (HPV), which is responsible for triggering most cases of cervical cancer. Approximately 60% of women are infected at some time with HPV. Most clear it from their system, but the vaccine does not work well in women who have ever encountered HPV.

Diagnoses and deaths in the 50 to 64 year-old age group are predicted to go up. The number of cases will rise by 62%, say epidemiologists at Queen Mary University London. That could push deaths up by 143%, from 183 in 2015 to 449 in 2040.

“The main reason for this is that the population is ageing and women currently 25-40 will not benefit from vaccination – and they are in the age range where the likelihood of getting an HPV infection is quite high,” said Dr Alejandra Castanon from Queen Mary, one of the authors.

Sexual practices among the 25 to 40 age group, and particularly having multiple partners, put them at greater risk of infection with the sexually-transmitted virus. “Unfortunately, the risk of acquiring an HPV infection that will progress to cancer has increased in unvaccinated individuals born since 1960, suggesting that current screening coverage is not sufficient to maintain – much less reduce – cervical cancer incidence in the next 20 years,” says the paper.

Cervical cancer may also now be thought of as less of a threat, even among women who have not been vaccinated. The older women get, the more likely they are to feel secure, particularly if they have one long-term partner. Perhaps as a result, fewer women have been going to be screened – but an infection takes at least 10 years to cause cancer.

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The authors and the charity Jo’s Cervical Cancer Trust, which funded the research, say there must be more effort to increase screening rates – and that the new more accurate form of screening, a test for HPV infection – is needed earlier than the planned introduction in 2019.

Robert Music, chief executive of the trust, said: “This research should serve as a wakeup call and the need for action. Continued declining cervical screening attendance will cost lives at all ages and must not happen. We are faced with an ageing population and risk among older women rocketing, therefore changes to the programme which could reduce this risk must be explored, including increasing the screening age from 64 and self-testing.”

In an editorial in the journal, Nicolas Wentzensen and Mark Schiffman from the National Cancer Institute in Bethesda, US, say there is an argument for vaccinating women up to the age of 30 in developing countries, after a test to establish they are not infected with HPV. This can help increase herd immunity, by reducing the amount of virus circulating in the community.

• This article was amended on 19 December 2017 to change Centers for Disease Control to National Cancer Institute.

