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Cited by 947Cervical Cancer and HPV ResearchWomen's cancer prevention and managementGlobal Cancer Incidence and Screening

Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries

Open access
Brisson, Marc, Kim, Jane J, Canfell, Karen, Drolet, Mélanie, Gingras, Guillaume, Burger, Emily A, Martin, Dave, Simms, Kate T +17 more·2020·The Lancet
DOI 10.1016/s0140-6736(20)30068-4PMC PMC7043009
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Abstract

BACKGROUND: The WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. To help inform global efforts, we modelled potential human papillomavirus (HPV) vaccination and cervical screening scenarios in low-income and lower-middle-income countries (LMICs) to examine the feasibility and timing of elimination at different thresholds, and to estimate the number of cervical cancer cases averted on the path to elimination. METHODS: The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC), which consists of three independent transmission-dynamic models identified by WHO according to predefined criteria, projected reductions in cervical cancer incidence over time in 78 LMICs for three standardised base-case scenarios: girls-only vaccination; girls-only vaccination and once-lifetime screening; and girls-only vaccination and twice-lifetime screening. Girls were vaccinated at age 9 years (with a catch-up to age 14 years), assuming 90% coverage and 100% lifetime protection against HPV types 16, 18, 31, 33, 45, 52, and 58. Cervical screening involved HPV testing once or twice per lifetime at ages 35 years and 45 years, with uptake increasing from 45% (2023) to 90% (2045 onwards). The elimination thresholds examined were an average age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years and ten or fewer cases per 100 000 women-years, and an 85% or greater reduction in incidence. Sensitivity analyses were done, varying vaccination and screening strategies and assumptions. We summarised results using the median (range) of model predictions. FINDINGS: Girls-only HPV vaccination was predicted to reduce the median age-standardised cervical cancer incidence in LMICs from 19·8 (range 19·4-19·8) to 2·1 (2·0-2·6) cases per 100 000 women-years over the next century (89·4% [86·2-90·1] reduction), and to avert 61·0 million (60·5-63·0) cases during this period. Adding twice-lifetime screening reduced the incidence to 0·7 (0·6-1·6) cases per 100 000 women-years (96·7% [91·3-96·7] reduction) and averted an extra 12·1 million (9·5-13·7) cases. Girls-only vaccination was predicted to result in elimination in 60% (58-65) of LMICs based on the threshold of four or fewer cases per 100 000 women-years, in 99% (89-100) of LMICs based on the threshold of ten or fewer cases per 100 000 women-years, and in 87% (37-99) of LMICs based on the 85% or greater reduction threshold. When adding twice-lifetime screening, 100% (71-100) of LMICs reached elimination for all three thresholds. In regions in which all countries can achieve cervical cancer elimination with girls-only vaccination, elimination could occur between 2059 and 2102, depending on the threshold and region. Introducing twice-lifetime screening accelerated elimination by 11-31 years. Long-term vaccine protection was required for elimination. INTERPRETATION: Predictions were consistent across our three models and suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most LMICs by the end of the century. Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden. FUNDING: WHO, UNDP, UN Population Fund, UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction, Canadian Institute of Health Research, Fonds de recherche du Québec-Santé, Compute Canada, National Health and Medical Research Council Australia Centre for Research Excellence in Cervical Cancer Control.

AI snapshot

Written from the paper’s full text.

TL;DR

In a comparative modelling analysis using three independent transmission-dynamic models, high-coverage girls-only HPV vaccination was projected to eliminate cervical cancer in most of 78 LMICs by the end of the century, with screening accelerating and extending elimination. Adding twice-lifetime screening was projected to achieve elimination in all 78 LMICs under all three thresholds and avert 74·1 million cases by 2120.

Key findings

  • Girls-only HPV vaccination reduced median age-standardised cervical cancer incidence in LMICs from 19·8 (range 19·4–19·8) to 2·1 (2·0–2·6) cases per 100 000 women-years over the next century (89·4% [86·2–90·1] reduction), averting 61·0 million (60·5–63·0) cases.
  • Adding twice-lifetime screening reduced incidence to 0·7 (0·6–1·6) cases per 100 000 women-years (96·7% [91·3–96·7] reduction) and averted an extra 12·1 million (9·5–13·7) cases; overall, intensive vaccination plus twice-lifetime screening was estimated to avert 74·1 million (70·4–75·1) cases by 2120.
  • Girls-only vaccination was predicted to eliminate cervical cancer in 60% (58–65) of LMICs at the ≤4 cases per 100 000 women-years threshold, 99% (89–100) at ≤10, and 87% (37–99) at ≥85% reduction; adding twice-lifetime screening reached 100% (71–100) for all three thresholds. Where vaccination alone sufficed, elimination occurred between 2059 and 2102, and screening accelerated elimination by 11–31 years.
  • Countries with the highest incidence (>25 cases per 100 000 women-years, mainly in sub-Saharan Africa) were not predicted to eliminate by vaccination alone; screening was required, and long-term vaccine protection was necessary for elimination.

Methods

  • WHO Cervical Cancer Elimination Modelling Consortium comparative modelling analysis using three independently developed transmission-dynamic models (HPV-ADVISE, Harvard, Policy1-Cervix) selected by predefined criteria, projecting cervical cancer incidence for 78 LMICs from 2020 to 2120.
  • Base-case scenarios: girls-only vaccination at age 9 years (catch-up to age 14 years), 90% coverage, 100% efficacy against HPV types 16, 18, 31, 33, 45, 52, and 58, lifelong protection; plus once-lifetime screening at age 35 years or twice-lifetime screening at ages 35 and 45 years, using HPV testing with uptake 45% (2023), 70% (2030), and 90% (2045 onwards), 100% treatment efficacy, and 10% loss to follow-up.
  • Outcomes were age-standardised cervical cancer incidence, relative reduction versus status quo, and cases averted; elimination thresholds were ≤4 and ≤10 cases per 100 000 women-years and ≥85% reduction; results reported as median (range) across models, with sensitivity analyses varying vaccination and screening assumptions.

Limitations

  • Stated: projections span >100 years, over which demographic, behavioural, and technological changes are anticipated; population growth affects cases averted (62 million with low UN population projections and 88 million with high projections versus 74 million base-case) but is expected to have minimal impact on age-standardised elimination timing, while changing sexual behaviour could lengthen time to elimination.
  • Stated: the analysis assumes intensive scale-up and 90% vaccination and screening uptake; slower scale-up would delay elimination and reduce cases averted but would not affect whether elimination can be achieved.
  • Stated: models omit plausible HIV–HPV biological interactions, potentially overestimating vaccination impact in high HIV prevalence settings (5 of 78 LMICs have HIV prevalence ≥10%), and rely on GLOBOCAN incidence estimates that may be underestimated, which could delay elimination. Evident: base-case assumptions of 100% vaccine efficacy, lifelong protection, 100% treatment efficacy, and only 10% loss to follow-up are idealized relative to real-world implementation, though sensitivity analyses partially address duration of protection and coverage.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/s0140-6736(20)30068-4

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

17 of 59 cited sources checked · 8 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    About 10% of cervical cancers are due to HPV types that are not in the currently available HPV vaccines.

    “about 10% of cervical cancers are due to HPV types that are not in the currently available HPV vaccines10”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [10] Serrano B Alemany L Tous S Potential impact of a nine-valent vaccine in human papillomavirus related cervical disease Infect Agent Cancer 7 2012 38 23273245 PMC3554470 source

      The Background identifies the then-current licensed vaccines as targeting HPV 16/18, which account for about 70% of cervical cancers. The Discussion says coverage would rise to almost 90% with five additional types in a nine-valent vaccine under development. The roughly 10% figure therefore applies to that proposed vaccine, not the currently available vaccines. (LLM, conf=0.92)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    Current HPV vaccination and cervical screening uptake is very low in most low-income and sub-Saharan African countries.

    “This is particularly important since current HPV vaccination and cervical screening uptake is very low in most low-income and sub-Saharan African countries.2, 3, 4, 5”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [2] PATH Global HPV Vaccine Introduction Overview: projected and current national introductions, demonstration/pilot projects, gender-neutral vaccination programs, and global HPV vaccine introduction maps (2006–2022) https://www.path.org/resources/global-hpv-vaccine-introduction-overview/ November, 2019

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [3] WHO Immunization, vaccines and biologicals: data, statistics and graphics https://www.who.int/immunization/monitoring_surveillance/data/en/

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [4] Gakidou E Nordhagen S Obermeyer Z Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities PLoS Med 5 2008 e132 18563963 PMC2429949 source

      The Abstract reports low cervical screening coverage in developing countries—19% on average—and Our Findings report effective coverage of 1% or less in Ethiopia. These findings support the screening portion, but the paper does not report HPV vaccination uptake or establish that both forms of uptake are very low in most low-income and sub-Saharan African countries. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    The consistency of the three models' results is partly because the key drivers of predictions (achievability and timing of elimination) are country-specific baseline cervical cancer incidence and percentage of cancers due to the HPV vaccine types, which were based on the same data sources.

    “Our results are consistent in part because the key drivers of our predictions (eg, achievability and timing of elimination) are country-specific baseline cervical cancer incidence and percentage of cancers due to the HPV vaccine types, which were based on the same data sources.1, 10”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [1] Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries CA Cancer J Clin 68 2018 394 424 30207593 source
    • cites [10] Serrano B Alemany L Tous S Potential impact of a nine-valent vaccine in human papillomavirus related cervical disease Infect Agent Cancer 7 2012 38 23273245 PMC3554470 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
  • Study design and conductcitation

    The models do not include plausible biological interactions between HIV and HPV (eg, HPV acquisition and disease progression might be increased among people living with HIV).

    “Thirdly, our models do not include plausible biological interactions between HIV and HPV (eg, HPV acquisition and disease progression might be increased among people living with HIV).51”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [51] Looker KJ Ronn MM Brock PM Evidence of synergistic relationships between HIV and Human Papillomavirus (HPV): systematic reviews and meta-analyses of longitudinal studies of HPV acquisition and clearance by HIV status, and of HIV acquisition by HPV status J Int AIDS Soc 21 2018 e25110 PMC5989783 29873885 source
  • Study design and conductcitation

    Country-specific cervical cancer incidence data are based on GLOBOCAN estimates, which, where possible, are derived from extrapolation of recent trends in incidence obtained from national or subnational population-based cancer registries.

    “Finally, our country-specific cervical cancer incidence data are based on GLOBOCAN estimates,42, 53 which, where possible, are derived from extrapolation of recent trends in incidence obtained from national or subnational population-based cancer registries.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [42] Ferlay J Ervik M Lam F Global Cancer Observatory: cancer today 2018 International Agency for Research on Cancer Lyon, France https://gco.iarc.fr/today

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [53] Ferlay J Colombet M Soerjomataram I Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods Int J Cancer 144 2019 1941 1953 30350310 source

      The ‘Estimates of cancer incidence by country’ section says GLOBOCAN predicted 2018 rates from recent national incidence data for 45 countries. It also used subnational registry data, but describes using recent rates as proxies or modelling incidence from mortality—not extrapolating recent subnational incidence trends. The source therefore supports the general description but not that specific account of the subnational method. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • May combine two claims. 31
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Premisecitation

    HPV vaccines are safe and highly effective against vaccine-type persistent infection and cervical precancerous lesions in women, with vaccine efficacy ≥93%.

    “Large international randomised control clinical trials have shown that HPV vaccines are safe and highly effective against vaccine-type persistent infection and cervical precancerous lesions in women (with vaccine efficacy ≥93%).6, 7, 8”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [6] Garland SM Hernandez-Avila M Wheeler CM Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases N Engl J Med 356 2007 1928 1943 17494926 source
    • cites [7] Paavonen J Naud P Salmeron J Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women Lancet 374 2009 301 314 19586656 source
    • cites [8] Joura EA Giuliano AR Iversen OE A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women N Engl J Med 372 2015 711 723 25693011 source

  • May combine two claims.

    Premisecitation

    The 9-valent HPV vaccine targets HPV types 16, 18, 31, 33, 45, 52, and 58, which cause about 90% of cervical cancers.

    “These vaccines target high-risk HPV types that cause about 70% (bivalent and quadrivalent vaccines: HPV types 16 and 18) and 90% (9-valent vaccine: HPV types 16, 18, 31, 33, 45, 52, and 58) of cervical cancers.9, 10”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [9] de Sanjose S Quint WG Alemany L Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study Lancet Oncol 11 2010 1048 1056 20952254 source
    • cites [10] Serrano B Alemany L Tous S Potential impact of a nine-valent vaccine in human papillomavirus related cervical disease Infect Agent Cancer 7 2012 38 23273245 PMC3554470 source

  • May combine two claims.

    Premisecitation

    Bivalent and quadrivalent HPV vaccines target HPV types 16 and 18, which cause about 70% of cervical cancers.

    “These vaccines target high-risk HPV types that cause about 70% (bivalent and quadrivalent vaccines: HPV types 16 and 18) and 90% (9-valent vaccine: HPV types 16, 18, 31, 33, 45, 52, and 58) of cervical cancers.9, 10”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [9] de Sanjose S Quint WG Alemany L Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study Lancet Oncol 11 2010 1048 1056 20952254 source
    • cites [10] Serrano B Alemany L Tous S Potential impact of a nine-valent vaccine in human papillomavirus related cervical disease Infect Agent Cancer 7 2012 38 23273245 PMC3554470 source

  • May combine two claims.

    Premisecitation

    Mathematical modelling studies have consistently shown that girls-only HPV vaccination and cervical cancer screen-and-treat programmes are cost-effective in LMICs.

    “Finally, mathematical modelling studies have consistently shown that girls-only HPV vaccination and cervical cancer screen-and-treat programmes are cost-effective in LMICs.17, 18, 19, 20, 21, 22”
    Quote in the paperNot a substantial claim2 of 6 sources checked
    • cites [17] Jit M Brisson M Portnoy A Hutubessy R Cost-effectiveness of female human papillomavirus vaccination in 179 countries: a PRIME modelling study Lancet Glob Health 2 2014 e406 e414 25103394 source
    • cites [18] Jit M Brisson M Potential lives saved in 73 countries by adopting multi-cohort vaccination of 9–14-year-old girls against human papillomavirus Int J Cancer 143 2018 317 323 29446090 PMC6001440 source

      The Discussion says routine HPV vaccination is cost-effective in almost all countries and suggests that vaccinating additional cohorts of girls could have a similar cost-effectiveness profile. The paper does not establish the cost-effectiveness of cervical cancer screen-and-treat programmes in LMICs, so it supports only the vaccination part of the cited sentence. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [19] Fesenfeld M Hutubessy R Jit M Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: a systematic review Vaccine 31 2013 3786 3804 23830973 source
    • cites [20] Campos NG Sharma M Clark A The health and economic impact of scaling cervical cancer prevention in 50 low- and lower-middle-income countries Int J Gynaecol Obstet 138 suppl 1 2017 47 56 28691334 source
    • cites [21] Campos NG Tsu V Jeronimo J Mvundura M Lee K Kim JJ When and how often to screen for cervical cancer in three low- and middle-income countries: a cost-effectiveness analysis Papillomavirus Res 1 2015 38 58

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [22] Canfell K Shi JF Lew JB Prevention of cervical cancer in rural China: evaluation of HPV vaccination and primary HPV screening strategies Vaccine 29 2011 2487 2494 21211586 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The comparative modelling analysis adhered to published guidelines for multi-model comparisons and for reporting model-based analyses of HPV vaccination and cervical screening.

    “This comparative modelling analysis adhered to recently published guidelines for multi-model comparisons28 and for reporting model-based analyses of HPV vaccination and cervical screening29 (appendix pp 26–28).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [28] den Boon S Jit M Brisson M Guidelines for multi-model comparisons of the impact of infectious disease interventions BMC Med 17 2019 163 31422772 PMC6699075 source
    • cites [29] Canfell K Kim JJ Kulasingam S HPV-FRAME: a consensus statement and quality framework for modelled evaluations of HPV-related cancer control Papillomavirus Res 8 2019 100184 PMC6804684 31505258 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Outcomes are presented with the median (range) of the predictions of the three models to represent between-model uncertainty.

    “Outcomes are presented with the median (range) of the predictions of the three models to represent between-model uncertainty.28”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [28] den Boon S Jit M Brisson M Guidelines for multi-model comparisons of the impact of infectious disease interventions BMC Med 17 2019 163 31422772 PMC6699075 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Combining cervical screening with HPV vaccination has been predicted to be cost-effective across several LMICs.

    “Furthermore, combining cervical screening with HPV vaccination has been predicted to be cost-effective across several LMICs.20, 21, 22”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [20] Campos NG Sharma M Clark A The health and economic impact of scaling cervical cancer prevention in 50 low- and lower-middle-income countries Int J Gynaecol Obstet 138 suppl 1 2017 47 56 28691334 source

      Section 3.2 reports that vaccination and screening were each estimated to be very cost-effective across the countries studied. But Section 2.2 says the paper calculated cost-effectiveness ratios separately and did not examine screening in vaccinated women, so it does not establish the cost-effectiveness of combining the interventions in the same population. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [21] Campos NG Tsu V Jeronimo J Mvundura M Lee K Kim JJ When and how often to screen for cervical cancer in three low- and middle-income countries: a cost-effectiveness analysis Papillomavirus Res 1 2015 38 58

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [22] Canfell K Shi JF Lew JB Prevention of cervical cancer in rural China: evaluation of HPV vaccination and primary HPV screening strategies Vaccine 29 2011 2487 2494 21211586 source

  • May combine two claims.

    Study design and conductcitation

    The study used a comparative modelling approach including three models that have been extensively peer reviewed and validated with post-vaccination surveillance data.

    “First, we used a comparative modelling approach including three models that have been extensively peer reviewed and validated with post-vaccination surveillance data.30, 31, 32, 33, 34, 35, 36”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [30] Van de Velde N Boily MC Drolet M Population-level impact of the bivalent, quadrivalent, and nonavalent human papillomavirus vaccines: a model-based analysis J Natl Cancer Inst 104 2012 1712 1723 23104323 source
    • cites [31] Brisson M Laprise JF Drolet M Comparative cost-effectiveness of the quadrivalent and bivalent human papillomavirus vaccines: a transmission-dynamic modeling study Vaccine 31 2013 3863 3871 23830974 source
    • cites [32] Burger EA Campos NG Sy S Regan C Kim JJ Health and economic benefits of single-dose HPV vaccination in a Gavi-eligible country Vaccine 36 2018 4823 4829 29807710 PMC6066173 source

      The Methods (Analytic overview; page unavailable) describe a three-tiered approach linking Harvard-HPV, Harvard-CC, and Harvard-Scale Up. The paper does not say that these three models were extensively peer reviewed or validated against post-vaccination surveillance data; the Methods (Simulation models; page unavailable) describe calibration to Ugandan epidemiological outcomes, which is not the same claim. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The study's projections are for more than 100 years, a period over which substantial demographic and behavioural changes and technological development are anticipated that can have an impact on cervical cancer incidence.

    “First, our projections are for more than 100 years, a period over which substantial demographic and behavioural changes and technological development are anticipated that can have an impact on cervical cancer incidence.43, 49”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [43] UN Department of Economic and Social Affairs World population prospects: 2017 revision https://population.un.org/wpp/Download/Standard/Population/ 2017 source
    • cites [49] Baussano I Lazzarato F Brisson M Franceschi S Human papillomavirus vaccination at a time of changing sexual behavior Emerg Infect Dis 22 2016 18 23 26691673 PMC4696692 source

      The Results (page unavailable) project that changing sexual behavior can increase HPV16 prevalence, supporting the concern that behavior may affect long-term projections. The paper does not project cervical cancer incidence over more than 100 years or address anticipated demographic changes and technological development. In the citing sentence, “our projections” refers to the citing authors’ work, not this source’s projections. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    In countries mainly in Asia, age-adjusted HPV infection and cervical cancer rates might be increasing, and thus time to elimination might be slightly longer than predicted.

    “In these countries (mainly in Asia), age-adjusted HPV infection and cervical cancer rates might be increasing,49 and thus time to elimination might be slightly longer than predicted.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [49] Baussano I Lazzarato F Brisson M Franceschi S Human papillomavirus vaccination at a time of changing sexual behavior Emerg Infect Dis 22 2016 18 23 26691673 PMC4696692 source

      The Results model an increase in HPV16 prevalence from 3% to 8% as sexual behavior changes, using rural India as an example of a traditional population. The cited paper does not establish increasing age-adjusted HPV infection rates across mainly Asian countries or increasing cervical cancer rates. The sentence’s prediction about time to elimination follows the citation and is not treated as attributed to this source. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    In the context of high-coverage girls-only vaccination, adding a third lifetime screen (to HPV vaccination and twice-lifetime screening) was predicted to provide very small additional gains in cervical cancer prevention, and only slightly accelerated time to elimination.

    “In the context of high-coverage girls-only vaccination, adding a third lifetime screen (to HPV vaccination and twice-lifetime screening) was predicted to provide very small additional gains in cervical cancer prevention, and only slightly accelerated time to elimination.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    HPV vaccination alone was predicted to result in elimination in all regions in the world, except for sub-Saharan Africa, where 27% (range 24-37) of countries would reach elimination, and Latin America and Caribbean, where 80% (80-80) of countries would reach elimination.

    “HPV vaccination alone was predicted to result in elimination in all regions in the world, except for sub-Saharan Africa, where 27% (range 24–37) of countries would reach elimination, and Latin America and Caribbean, where 80% (80–80) of countries would reach elimination.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Although twice-lifetime screening without HPV vaccination would substantially reduce cervical cancer incidence, the age-standardised cervical cancer incidence would remain higher than four cases per 100 000 women-years in the countries examined.

    “A sensitivity analysis examining the impact of screening suggests that although twice-lifetime screening without HPV vaccination would substantially reduce cervical cancer incidence, the age-standardised cervical cancer incidence would remain higher than four cases per 100 000 women-years in the countries examined (appendix pp 10–11).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The duration of protection and the number of types included in the HPV vaccine can affect whether girls-only HPV vaccination with twice-lifetime screening leads to cervical cancer elimination.

    “our sensitivity analysis showed that the duration of protection and the number of types included in the HPV vaccine can affect whether girls-only HPV vaccination with twice-lifetime screening leads to cervical cancer elimination (appendix pp 10–11).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Multi-age cohort vaccination up to age 25 years would substantially accelerate the declines in cervical cancer incidence, but would not change cervical cancer incidence at equilibrium.

    “the models predicted that multi-age cohort vaccination up to age 25 years would substantially accelerate the declines in cervical cancer incidence, but would not change cervical cancer incidence at equilibrium (appendix pp 10–11).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    HPV vaccination and twice-lifetime screening will avert 49·9 million (range 49·5-50·9) cases in sub-Saharan Africa over the next century, which represents about 70% of all cases averted in LMICs.

    “our models predicted that HPV vaccination and twice-lifetime screening will avert 49·9 million (range 49·5–50·9) cases in sub-Saharan Africa over the next century, which represents about 70% of all cases averted in LMICs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    A small reduction in HPV vaccination coverage from 90% to 80% would have little impact on the decline in cervical cancer incidence in the first 30 years following girls-only HPV vaccination (without screening), but would lead to slightly higher long-term incidence.

    “The sensitivity analysis suggests that a small reduction in HPV vaccination coverage from 90% to 80% would have little impact on the decline in cervical cancer incidence in the first 30 years following girls-only HPV vaccination (without screening), but would lead to slightly higher long-term incidence (appendix pp 10–11).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    With low UN population predictions, 62 million cervical cancer cases would be averted with the triple-intervention strategy; with high UN population predictions, 88 million cases would be averted; versus 74 million cases with base-case projections.

    “When producing projections with low population predictions from the UN,43 we estimated that 62 million cervical cancer cases would be averted with the triple-intervention global elimination strategy, and that 88 million cases would be averted with the UN's high population predictions, versus 74 million cases with base-case projections (appendix p 12).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] UN Department of Economic and Social Affairs World population prospects: 2017 revision https://population.un.org/wpp/Download/Standard/Population/ 2017 source
    • The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.

  • May combine two claims.

    Findingown data

    All vaccination strategies will achieve elimination, except for girls-only vaccination with 80% coverage.

    “The models predicted that all vaccination strategies will achieve elimination, except for girls-only vaccination with 80% coverage.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Cervical cancer elimination can be achieved in all but three LMICs (in sub-Saharan Africa) with once-lifetime screening and in all LMICs with twice-lifetime screening.

    “Additionally, cervical cancer elimination can be achieved in all but three LMICs (in sub-Saharan Africa) with once-lifetime screening and in all LMICs with twice-lifetime screening.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.

  • May combine two claims.

    Findingown data

    Including screening in addition to HPV vaccination would substantially increase the number of cervical cancer cases averted and would accelerate elimination, mainly by preventing cases in older, unvaccinated women.

    “Our results suggest that including screening in addition to HPV vaccination would substantially increase the number of cervical cancer cases averted and would accelerate elimination, mainly by preventing cases in older, unvaccinated women.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.

  • May combine two claims.

    Findingreasoning

    Multi-age cohort vaccination up to 25 years of age was predicted to substantially accelerate elimination and avert additional cervical cancer cases but would have no effect on whether a country reaches elimination, which is only determined by long-term routine vaccination coverage.

    “Multi-age cohort vaccination up to 25 years of age was predicted to substantially accelerate elimination and avert additional cervical cancer cases but would have no effect on whether a country reaches elimination, which is only determined by long-term routine vaccination coverage.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.

  • May combine two claims.

    Findingown data

    In doing so, cervical cancer incidence would be reduced by 97% and more than 74 million cases would be averted over the next century.

    “In doing so, cervical cancer incidence would be reduced by 97% and more than 74 million cases would be averted over the next century.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The LMICs unable to achieve elimination through vaccination alone under the proposed threshold have the highest burden of cervical cancer (incidence >25 per 100 000 women-years) and are mostly in sub-Saharan Africa.

    “These countries have the highest burden of cervical cancer (incidence >25 per 100 000 women-years) and are mostly in sub-Saharan Africa.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The triple-intervention strategy would accelerate elimination by 11-31 years and prevent an additional 12 million cervical cancer cases over the next century compared with vaccination alone.

    “the triple-intervention strategy was chosen as the global elimination strategy as it would accelerate elimination by 11–31 years and prevent an additional 12 million cervical cancer cases over the next century (compared with vaccination alone).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.

  • May combine two claims.

    Findingown data

    Cervical cancer elimination as a public health problem is possible by the end of the century, resulting in a 97% reduction in cervical cancer incidence in LMICs.

    “In conclusion, our comparative modelling analysis suggests that cervical cancer elimination as a public health problem is possible by the end of the century, resulting in a 97% reduction in cervical cancer incidence in LMICs.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cervical cancer is the second most frequent cancer among women in LMICs.

    “Cervical cancer is the second most frequent cancer among women in low-income and lower-middle-income countries (LMICs).1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries CA Cancer J Clin 68 2018 394 424 30207593 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Model predictions were done independently by each group and collated by the study's coordinating centre.

    “The model predictions were done independently by each group and collated by the study's coordinating centre (Laval University, Québec, QC, Canada).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The three CCEMC models were calibrated to highly stratified sexual behaviour and epidemiological data, validated to clinical trials or post-vaccination data, or both, and reproduce age-specific cervical cancer incidence estimates from GLOBOCAN 2018 for all 78 LMICs.

    “Finally, all models were calibrated to highly stratified sexual behaviour and epidemiological data, validated to clinical trials or post-vaccination data, or both, and reproduce the age-specific cervical cancer incidence estimates from the Global Cancer Observatory (GLOBOCAN) 2018 for all 78 LMICs42”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] Ferlay J Ervik M Lam F Global Cancer Observatory: cancer today 2018 International Agency for Research on Cancer Lyon, France https://gco.iarc.fr/today

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Impact predictions were done without harmonising the basic structure of the models or parameters governing the setting and disease.

    “Impact predictions were done without harmonising the basic structure of the models or parameters governing the setting and disease.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Countries with the highest cervical cancer incidence at present (>25 cases per 100 000 women-years), more than 90% of which are in sub-Saharan Africa, would not reach elimination by vaccination alone.

    “However, countries with the highest cervical cancer incidence at present (>25 cases per 100 000 women-years), more than 90% of which are in sub-Saharan Africa, would not reach elimination by vaccination alone.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    To achieve global elimination by the end of the century, the 2030 targets need to be met in the countries with the highest burden of cervical cancer, and these countries also need to be supported to scale up twice-lifetime screening from 70% to 90% by 2045.

    “Our findings suggest that to achieve global elimination by the end of the century, these targets need to be met in the countries with the highest burden of cervical cancer, and these countries also need to be supported to scale up twice-lifetime screening from 70% to 90% by 2045.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The modelling results were presented and discussed at multiple WHO advisory group and global stakeholder meetings.

    “Additionally, the modelling results were presented and discussed at multiple WHO advisory group and global stakeholder meetings.24, 39, 48”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [24] WHO Draft: global strategy towards eliminating cervical cancer as a public health problem https://www.who.int/docs/default-source/cervical-cancer/cervical-cancer-elimination-strategy.pdf?sfvrsn=8a083c4e_0 Dec 16, 2019

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [39] WHO Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC) recommendations. Sept 2018 Wkly Epidemiol Rec 94 2019 5 16

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [48] WHO Strategic Advisory Group of Experts on Immunization. Working Group on human papillomavirus (HPV) immunization—conclusions and recommendations https://www.who.int/immunization/sage/meetings/2018/october/3_SAGE2018_WG_recommendation_FINAL.pdf?ua=1 Sept 27–28, 2018

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The base-case vaccination-only strategy (routine girls-only HPV vaccination at age 9 years with a 1-year multi-age cohort catch-up for girls aged 10-14 years) is the recommended strategy by WHO SAGE and is highly cost-effective in LMICs and high-income countries.

    “This strategy was chosen as it is the recommended strategy by the WHO Strategic Advisory Group of Experts on Immunization (SAGE)41 and a large body of evidence shows that it is highly cost-effective in LMICs and high-income countries.17, 19, 31, 32”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [41] WHO Immunization, vaccines and biologicals: human papillomavirus (HPV) https://www.who.int/immunization/diseases/hpv/en/

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [17] Jit M Brisson M Portnoy A Hutubessy R Cost-effectiveness of female human papillomavirus vaccination in 179 countries: a PRIME modelling study Lancet Glob Health 2 2014 e406 e414 25103394 source
    • cites [19] Fesenfeld M Hutubessy R Jit M Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: a systematic review Vaccine 31 2013 3786 3804 23830973 source

  • Classified as probably not a substantial claim.

    Premisereasoning

    SAGE recommended in October, 2019, that multi-age cohort catch-up vaccination for girls aged 10-14 years should be postponed to alleviate the demand for vaccine doses in the coming years.

    “SAGE recommended in October, 2019, that multi-age cohort catch-up vaccination for girls aged 10–14 years should be postponed to alleviate the demand for vaccine doses in the coming years.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Key knowledge users from WHO were involved in all aspects of the study, from its design to interpretations of findings.

    “Second, key knowledge users from WHO were involved in all aspects of the study, from its design to interpretations of findings.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The analysis includes projections from three independent transmission-dynamic models.

    “Our comparative modelling analysis, which includes projections from three independent transmission-dynamic models”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The two base-case screening strategies (primary HPV screen-and-treat testing with once-lifetime and twice-lifetime screening) are the recommended strategies by WHO.

    “The two base-case screening strategies examined, primary HPV screen-and-treat testing with once-lifetime and twice-lifetime screening, were chosen as they are the recommended strategies by WHO.40”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] WHO Early diagnosis and screening: cervical cancer https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    To achieve cervical cancer elimination in all 78 LMICs, scale-up of both girls-only HPV vaccination and twice-lifetime screening is necessary, with 90% HPV vaccination coverage, 90% screening uptake, and long-term protection against HPV types 16, 18, 31, 33, 45, 52, and 58.

    “To achieve cervical cancer elimination in all 78 LMICs, our models predict that scale-up of both girls-only HPV vaccination and twice-lifetime screening is necessary, with 90% HPV vaccination coverage, 90% screening uptake, and long-term protection against HPV types 16, 18, 31, 33, 45, 52, and 58.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many countries have cervical cancer incidence higher than 40 cases per 100 000 women-years.

    “many countries have cervical cancer incidence higher than 40 cases per 100 000 women-years.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries CA Cancer J Clin 68 2018 394 424 30207593 source

  • May combine two claims.

    Interpretationreasoning

    For the countries with cervical cancer incidence greater than the threshold despite vaccination, high cervical screening uptake will have to be sustained for elimination to be maintained (or additional types would have to be included in future HPV vaccines).

    “For these countries, high cervical screening uptake will have to be sustained for elimination to be maintained (or additional types would have to be included in future HPV vaccines).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The recommendations were partly based on results from HPV-ADVISE showing that these strategies would produce similar benefits to girls-only vaccination at age 9 years with a 1-year catch-up for girls aged 10-14 years.

    “The recommendations were partly based on results from HPV-ADVISE showing that these strategies would produce similar benefits to girls-only vaccination at age 9 years with a 1-year catch-up for girls aged 10–14 years.46”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [46] Brisson M Jit M Bénard É Optimal HPV immunization strategies in the context of limited resources & vaccine supply. WHO-SAGE meeting https://www.who.int/immunization/sage/meetings/2019/october/brisson_hpv_sage_october_2019.pdf Oct 9, 2019

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    By not capturing HIV-HPV interactions, the models might overestimate the impact of HPV vaccination in high HIV prevalence settings (five of 78 LMICs have HIV prevalence ≥10%).

    “By not capturing such interactions, our models might overestimate the impact of HPV vaccination in high HIV prevalence settings (five of 78 LMICs have HIV prevalence ≥10%52).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] WHO Global Health Observatory data repository. Number of people (all ages) living with HIV, estimates by country http://apps.who.int/gho/data/view.main.22100?lang=en

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Sexual behaviour has been changing in many LMICs, from a more traditional pattern to a more sex-similar pattern.

    “Sexual behaviour has been changing in many LMICs, from a more traditional pattern of sexual behaviour, with a lower reported number of lifetime partners and wider age gaps between partners, to a more sex-similar pattern of behaviour, where both sexes have a similar and higher number of partners and narrow age gaps.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    If scale-up is slower than modelled, this would delay the predicted timing of elimination and reduce the number of cancer cases averted, but it would not affect whether or not elimination can be achieved.

    “If scale-up is slower than modelled, this would delay the predicted timing of elimination and reduce the number of cancer cases averted, but it would not affect whether or not elimination can be achieved.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Specific prevention strategies might be required for people living with HIV to accelerate cervical cancer elimination in high HIV prevalence settings.

    “Specific prevention strategies might be required for people living with HIV to accelerate cervical cancer elimination in high HIV prevalence settings.”
    Quote in the paperNot a substantial claim
46 of 46

  • The authors state this as an assumption.

    HPV vaccines are prophylactic and vaccination produces post-vaccination herd effects.

    “All models assume that HPV vaccines are prophylactic and capture post-vaccination herd effects.”

  • The authors state this as an assumption.

    Countries follow SAGE recommendations.

    “assuming countries follow SAGE recommendations”

  • The authors state this as an assumption.

    Supply constraints are relieved over the next decade.

    “provided supply constraints are relieved over the next decade”

  • The authors state this as an assumption.

    Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.

    “we assumed intensive scale-up and 90% uptake of HPV vaccination and cervical screening.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • HPV vaccination of adolescent girls will help reduce cervical cancer incidence in low- and middle-income countries by more than 85% over the next century.

    “Although HPV vaccination of adolescent girls will help in reducing cervical cancer incidence in low- and middle-income countries (LMICs) by more than 85% over the next century [4], adult women who do not benefit by the preventive HPV vaccines need immediate intervention of cervical cancer screening and appropriate management of pre-cancers to prevent cervical cancers.”

    From Performance of HPV Self-Sample Collected by a Novel Kit in Comparison with Clinician Collected Sample for Cervical Cancer Screening (2024) · cites this paper as [4]

    The Results project an 89.4% reduction in cervical cancer incidence over the next century with girls-only HPV vaccination, supporting the claimed magnitude. That projection assumes 90% vaccination coverage, and the study covers low-income and lower-middle-income countries rather than all middle-income countries; the citing sentence omits those limits. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Our projections support previous modelling studies that found high coverage HPV16/18 vaccination in girls aged 10 years could considerably reduce cervical cancer burden in India and enable reaching the WHO elimination target even with single-dose vaccination.

    “Our projections also support previous modelling studies2, 31, 32 that found high coverage of vaccination against HPV16 and HPV18 in girls aged 10 years could reduce the burden of cervical cancer in India considerably, and enable the country to reach the WHO elimination target even with single-dose vaccination.”

    From Evidence-based impact projections of single-dose human papillomavirus vaccination in India: a modelling study (2022) · cites this paper as [2]

    The Abstract Methods and Findings support the broad prediction that high-coverage girls-only HPV vaccination could substantially reduce cervical cancer incidence, and the Results say an HPV16/18-only vaccine might permit elimination in some LMICs. But the model’s base case vaccinated girls at age 9 with catch-up through age 14 and assumed lifetime protection; our copy does not establish the claimed India-specific elimination result with single-dose vaccination. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Using GLOBOCAN baseline estimates would make reaching the WHO elimination threshold more difficult but still possible under high vaccine coverage and efficacy.

    “Using GLOBOCAN estimates would make reaching the WHO elimination threshold more difficult, but should still be possible under high vaccine coverage and efficacy.2, 31”

    From Evidence-based impact projections of single-dose human papillomavirus vaccination in India: a modelling study (2022) · cites this paper as [2]

    The Discussion (page not provided) says the models used GLOBOCAN incidence estimates and that underreporting could mean elimination takes longer than predicted. It does not say that using GLOBOCAN estimates itself makes elimination harder. It also says high-burden countries need screening in addition to high vaccination coverage to reach the WHO threshold; vaccine coverage and efficacy alone are not sufficient across all countries. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Cervical cancer could be eliminated as a public health problem with appropriate preventive measures.

    “Yet, cervical cancer could be eliminated as a public health problem with appropriate preventive measures.2”

    From Evidence-based impact projections of single-dose human papillomavirus vaccination in India: a modelling study (2022) · cites this paper as [2]

  • Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden.

    “Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden.”

    From HPV self-sampling for cervical cancer screening: a systematic review of values and preferences (2021) · cites this paper as [98]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Elimination-year median falls outside its reported range

    Minor

    The table reports 2073 as the median elimination year and 2078-2079 as its range. A median of three model predictions cannot fall below the minimum of those predictions.

  • The 44-country income group is labelled as all LMICs

    Minor

    The table labels a 44-country income group as "low-income and lower-middle-income countries," but elsewhere labels all low-income and lower-middle-income countries as a 78-country group. The 44-country label is inconsistent with the table's own total.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. 2019, Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC) recommendations. Sept 2018, Wkly Epidemiol Rec, 94, 5

Cited by

Sorted by citations

Related

Authors
Brisson, M., Kim, J. J., Canfell, K., Drolet, M., Gingras, G., Burger, E. A., Martin, D., Simms, K. T., Bénard, É., Boily, M.-C., Sy, S., Regan, C., Keane, A., Caruana, M., Nguyen, D. T. N., Smith, M. A., Laprise, J.-F., Jit, M., Alary, M., Bray, F., Fidarova, E., Elsheikh, F., Bloem, P. J. N., Broutet, N., & Hutubessy, R.
Affiliations
  • Université Laval (CA)
  • Harvard University (US)
  • The University of Sydney (AU)
  • Centre de recherche du CHU de Québec-Université Laval (CA)
  • Public Health England (GB)
  • Institut National de Santé Publique du Québec (CA)
  • Centre international de recherche sur le cancer (FR)
  • World Health Organization (CH)
Corresponding author
Brisson, Marc
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2020-02
Volume
395
Issue
10224
Pages
575-590
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(20)30068-4
PMC
PMC7043009
OpenAlex
W3003249044
Semantic Scholar
86b4018633d5c25bf1575a9cf09520869a994585
Cited by
943
References
37
Citations by year
2026: 131 · 2025: 174 · 2024: 177 · 2023: 147 · 2022: 126 · 2021: 137 · 2020: 50 · 2019: 1
FWCI
70.75
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
  • Spiral (Imperial College London) (submittedVersion, other-oa)
Funders
European Union (MR/R015600/1)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
cervical cancer elimination, HPV vaccination, cervical cancer screening, cervical cancer incidence, vaccination coverage, screening uptake, incidence reduction, case averted
MeSH terms
Adult, Uterine Cervical Neoplasms, Developing Countries, Feasibility Studies, Female, Humans, Income, Mass Screening, Models, Biological, Vaccination, Incidence, Papillomavirus Infections, Papillomavirus Vaccines, Early Detection of Cancer

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-16.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-16.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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