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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 accessAbstract
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.
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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.
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Claims the paper makes
73 Own result · 30 Own interpretation · 9 No full text of the sources · 8 Partly supported · 6 Sources not found · 6 Own method · 6 No basis given · 3 Supported · 3 Supported so far · 1 Not supported · 1 Not checked yet · accuracy not yet measured
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“about 10% of cervical cancers are due to HPV types that are not in the currently available HPV vaccines10”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Disputedcites [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 sourceExperimental — accuracy not yet measured
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.
plaindirect- Asserted: passes — The authors put it forward as true.
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- Disputed
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In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Not matchedcites [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.
- Not matchedcites [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.
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Not matched
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In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Not checked — no full text of the sourcecites [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
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Every source the paper cites for this claim was checked and supports it.
In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Supportedcites [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
The Introduction states that HPV acquisition and disease progression may be increased among people with immunodeficiencies, including those caused by HIV. The citation supports the biological-interaction example; the statement about what the citing authors’ own models omit is not attributed to this source. Page numbers were not supplied. (LLM, conf=0.95)
plain- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
- Supported
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In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Not matchedcites [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.
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
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)
hedged- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and in 87% (37–99) of LMICs based on the 85% or greater reduction threshold.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Abstract > Findings
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When adding twice-lifetime screening, 100% (71–100) of LMICs reached elimination for all three thresholds.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Abstract > Findings
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and averted an extra 12·1 million (9·5–13·7) cases.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Abstract > Findings
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Long-term vaccine protection was required for elimination.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Abstract > Findings
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
- Also stated in: § Results · plain
“HPV vaccination and twice-lifetime screening was predicted to reduce the average age-standardised cervical cancer incidence to 0·7 (0·6–1·6) cases per 100 000 women-years at equilibrium (96·7% [91·3–96·7] reduction).”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Abstract > Findings
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Also stated in: § Results · plain
- It may state two separate claims as one. 31
- Probably not a substantial claim. 16
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Introduction
What the sources say
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
- Supportedcites [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
The Incidence of Disease section reports 96.0% efficacy against persistent infection and 96.3% efficacy against high-grade cervical disease associated with HPV types 31, 33, 45, 52, and 58 in the per-protocol population, compared with the quadrivalent vaccine. The Adverse Events section reports generally similar systemic adverse-event rates, though injection-site events were more frequent with the 9-valent vaccine. These findings support the citing sentence for the 9-valent vaccine under the trial’s conditions. (LLM, conf=0.90)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Introduction
What the sources say
- Not checked — no full text of the sourcecites [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
- Supportedcites [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 Results (Cervical cancer) report that HPV 16/18 account for almost 70% of cervical cancers worldwide and the five additional high-risk types account for 18.5%, bringing their combined contribution to about 90%. The vaccine also includes HPV 6/11, but the paper says those types add only 0.1% to the cervical-cancer estimate. (LLM, conf=0.93)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Introduction
What the sources say
- Not checked — no full text of the sourcecites [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
- Supportedcites [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 states that Cervarix targets HPV 16/18, which cause about 70% of cervical cancer cases, and that Gardasil targets those same two cancer-causing types. The Results (Cervical cancer) also report that HPV 16/18 account for almost 70% worldwide. (LLM, conf=0.94)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Introduction
What the sources say
- Not checked — no full text of the sourcecites [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
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
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)
- Not checked — no full text of the sourcecites [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
- Supportedcites [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
The Abstract and §3.2 describe model-based estimates for HPV vaccination of 10-year-old girls and screening with treatment when needed for 35-year-old women in 50 low- and lower-middle-income countries. Section 3.2 finds both very cost-effective and says its vaccination estimate is consistent with published literature; it also reports cost-effective screen-and-treat findings from other analyses. (LLM, conf=0.93)
- Not matchedcites [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.
- Not checked — no full text of the sourcecites [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
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“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).”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Methods > Comparative modelling approach
What the sources say
- Supportedcites [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
The Background section identifies this paper as presenting guidelines for multi-model comparisons of infectious disease interventions, which is what citation 28 identifies. The claim of adherence concerns the citing authors’ own analysis; the separate HPV reporting guidelines are attributed to citation 29, not this source. (LLM, conf=0.91)
- Supportedcites [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
The citation to HPV-FRAME is attached to the guidelines for reporting model-based analyses of HPV vaccination and cervical screening, not to the separate multi-model-comparison guidelines. Domain 6 describes reporting standards for cervical screening models, including models that combine screening and vaccination. The citing authors’ assertion that their own analysis adhered to those standards is not something this source establishes. (LLM, conf=0.91)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Outcomes are presented with the median (range) of the predictions of the three models to represent between-model uncertainty.28”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Methods > Outcomes
What the sources say
- Supportedcites [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
The ‘Presenting and pooling results > Good practice’ section describes reporting the median with minimum and maximum model estimates to show variability between model predictions. The reference to three models describes the citing authors’ application of that method, not a requirement attributed to the guideline. (LLM, conf=0.91)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Furthermore, combining cervical screening with HPV vaccination has been predicted to be cost-effective across several LMICs.20, 21, 22”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
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)
- Not matchedcites [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.
- Not checked — no full text of the sourcecites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
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)
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Not checked — no full text of the sourcecites [43] UN Department of Economic and Social Affairs World population prospects: 2017 revision https://population.un.org/wpp/Download/Standard/Population/ 2017 source
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
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)
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
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)
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Results
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Results
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Results
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Results
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Results
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Results
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Results
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Not checked — no full text of the sourcecites [43] UN Department of Economic and Social Affairs World population prospects: 2017 revision https://population.un.org/wpp/Download/Standard/Population/ 2017 source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The models predicted that all vaccination strategies will achieve elimination, except for girls-only vaccination with 80% coverage.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Results
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In doing so, cervical cancer incidence would be reduced by 97% and more than 74 million cases would be averted over the next century.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“These countries have the highest burden of cervical cancer (incidence >25 per 100 000 women-years) and are mostly in sub-Saharan Africa.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
plaincorrelationaln = 4- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.
In the paper
“Cervical cancer is the second most frequent cancer among women in low-income and lower-middle-income countries (LMICs).1”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Introduction
What the sources say
- Not checked — no full text of the sourcecites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The model predictions were done independently by each group and collated by the study's coordinating centre (Laval University, Québec, QC, Canada).”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Methods > Outcomes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Methods > Model description
What the sources say
- Not matchedcites [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.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Impact predictions were done without harmonising the basic structure of the models or parameters governing the setting and disease.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Methods > Comparative modelling approach
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: Intensive scale-up and 90% uptake of HPV vaccination and cervical screening.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“Additionally, the modelling results were presented and discussed at multiple WHO advisory group and global stakeholder meetings.24, 39, 48”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Not matchedcites [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.
- Not matchedcites [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.
- Not matchedcites [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.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Not matchedcites [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.
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Not matched
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, key knowledge users from WHO were involved in all aspects of the study, from its design to interpretations of findings.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our comparative modelling analysis, which includes projections from three independent transmission-dynamic models”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Not matchedcites [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.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“many countries have cervical cancer incidence higher than 40 cases per 100 000 women-years.1”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Not checked — no full text of the sourcecites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Not matchedcites [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.
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Not matched
In the paper
“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).”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
What the sources say
- Not matchedcites [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.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Specific prevention strategies might be required for people living with HIV to accelerate cervical cancer elimination in high HIV prevalence settings.”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
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.”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Results
“2073 (2078–2079)”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Results
“Data are median (range) predictions from three dynamic models.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Results
“Low-income and lower-middle-income countries (n=44)”
§ Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries > Results
“All low-income and lower-middle-income countries (n=78)”
Citations
Cites
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Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases
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Self-citationHPV Screening for Cervical Cancer in Rural India
Sankaranarayanan, R., Nene, B. M., Shastri, S. S., Jayant, K., Muwonge, R., Budukh, A. M., Hingmire, S., Malvi, S. G., Thorat, R., Kothari, A., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0808516 · Cited by 1,278
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Research works printed but not linked: 1
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Cited by
Sorted by citations
Items 601–700 of 947
Ulusal Takvim Dışındaki Pediatrik Aşılar Hakkında Bilinmesi Gerekenler: Güncel Yaklaşım
Aslan, M. (2024) · JOURNAL OF BIOTECHNOLOGY AND STRATEGIC HEALTH RESEARCH · doi:10.34084/bshr.1529254 · Cited by 1
Sachelarie, L., Maghiar, L., & Huniadi, A. C. (2024) · Journal of Medicine and Life · doi:10.25122/jml-2023-0329 · Cited by 1
Wang, J., & Zhang, N. (2024) · Cell Biochemistry and Biophysics · doi:10.1007/s12013-024-01458-8 · Cited by 1
Value of Combined HPV E6/E7 and Thinprep Cytologic Test in the Screening of Cervical Cancer
霍, 媛. (2024) · Asian Case Reports in Emergency Medicine · doi:10.12677/acrem.2024.124020 · Cited by 1
Modelling epidemiological and economics processes – the case of cervical cancer
Taeger, F., Mende, L., & Fleßa, S. (2025) · Health Economics Review · doi:10.1186/s13561-024-00589-1 · Cited by 1
Implementation of Clinical Practice Guidelines to Prevent Cervical Cancer: Mixed Methods Study
Ezechi, O., Akinsolu, F. T., Abodunrin, O. R., Ola, O. M., Obi‐Jeff, C., Lawal, I. K., Eleje, G. U., Tucker, J. D., & Iwelunmor, J. (2025) · JMIR Cancer · doi:10.2196/68572 · Cited by 1
“Meeting these targets in low and middle-income countries, including Nigeria, could reduce new cervical cancer cases by 97% (74 million cases) and prevent 62 million deaths by 2120 [23].”
Kariuki, H. W., Nyamari, C. K., Waweru, P., et al. (2025) · Cureus · doi:10.7759/cureus.83191 · Cited by 1
“Cervical cancer screening programs have proved effective in reducing the burden of this disease in most high-income countries [18,19].”
Wu, X.-C., Chen, X., Zhang, X. Y., et al. (2025) · PeerJ · doi:10.7717/peerj.19387 · Cited by 1
“…sex partners, smoking, immunocompromised status ( e.g ., AIDS), chlamydia infection, long-term use of oral contraceptives, having multiple full-term pregnancies, young age at fi rst full-term pregnancy, low economic status, and low consumption offruits and vegetables ( Brisson et al., 2020 ).”
Human papillomavirus vaccination: if the vaccine is important and available, why not use it?
Freire, G. S., Amaral, C. L. R., Romano, J. J., et al. (2025) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.20240865 · Cited by 1
Qiu, Z., Huang, Y., Qiu, Z., Guo, Z., Wang, L., Xu, M., & Xuan, F. (2025) · Journal of Global Health · doi:10.7189/jogh.15.04161 · Cited by 1
“…the absolute number of cervical cancer-related DALYs due to changes in disease severity was highest in Low and low-middle SDI regions between 1990 and 2021, nearly 94% of cervical cancer deaths in 2022 were in LMICs, and vaccination rates were still lower than in high-income countries [ 43 , 44 ].”
Diakite, I., Kyle, J., Situ, S., Wang, W., Zhang, X., Wang, Y., Bian, R., Wu, H., Wang, X. S., Chen, Y., et al. (2025) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2025.2528426 · Cited by 1
Supplisson, O., Tessandier, N., Roussel, M., et al. (2025) · Eurosurveillance · doi:10.2807/1560-7917.es.2025.30.28.2400689 · Cited by 1
Zhang, J., Wen, K., Liang, J., et al. (2025) · Journal of Lower Genital Tract Disease · doi:10.1097/lgt.0000000000000907 · Cited by 1
Zahid, S., Alnuaimi, B., Tamimi, K., et al. (2025) · Cureus · doi:10.7759/cureus.93179 · Cited by 1
“Additionally, widespread HPV vaccination indirectly protects unvaccinated individuals through herd immunity, further amplifying its public health benefits [21].”
Tazi, A. (2025) · médecine/sciences · doi:10.1051/medsci/2025129 · Cited by 1
Li, Y., Wei, X., & Li, Y. (2025) · Future Microbiology · doi:10.1080/17460913.2025.2567700 · Cited by 1
“…and HPV prophylactic vaccines are still not available globally due to factors such as economic disparities between different countries and regions, as well as the inability to eradicate preexisting infections, which creates an economic burden and population loss worldwide especially in Asia [2].”
Sozib, M. S. I., Smail, L., & Jassim, G. (2025) · Future Oncology · doi:10.1080/14796694.2025.2575519 · Cited by 2
Prevalence characteristics of human papillomavirus among women in Henan Province of China
Zhu, X., Li, S., & Zhuang, C. (2025) · Virology Journal · doi:10.1186/s12985-025-02953-x · Cited by 1
“Therefore, we should simultaneously strengthen vaccination efforts for teenagers and HPV screening for the elderly regularly [31, 32].”
Liu, W., Li, J., Huang, X., Huang, H., Jiang, K., & Lu, W. D. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1508623 · Cited by 1
Meenakshisundaram, N., & Sajiv, G. (2025) · International Conference on Electronics and Sustainable Communication Systems (ICESC) · doi:10.1109/icesc65114.2025.11212506 · Cited by 1
Jiang, Q., Xu, R., Cheng, J., et al. (2025) · Journal of Pharmaceutical and Biomedical Analysis · doi:10.1016/j.jpba.2025.117232 · Cited by 1
The impact of HIV on cervical cancer elimination in KwaZulu-Natal: a comparative modeling analysis
Hathaway, C., Hall, M. T., de Bondt, D. D., et al. (2025) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djaf364 · Cited by 1
“18,19 However, due to the interactions between HIV and HPV, the combined impact of these programs on CC remains unclear.”
Self-citationImpact of vaccination against human papillomavirus: Towards cervical cancer elimination
Alemany, L., & Brotons, M. (2025) · Vacunas (English Edition) · doi:10.1016/j.vacune.2025.500485 · Cited by 1
Ikken, Y., Hassou, N., Ahnyne, R., et al. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-30225-1.00014-2 · Cited by 1
Sørbye, S. W., Antonsen, M., & Richardsen, E. H. (2025) · Vaccines · doi:10.3390/vaccines14010044 · Cited by 1
Han, W. M., Han, W. M., Neesgaard, B., et al. (2026) · EClinicalMedicine · doi:10.1016/j.eclinm.2025.103739 · Cited by 1
“Nonetheless, differences in historical HPV vaccination coverage and cervical cancer screening practices and prevention strategies 44–46 may still contribute to the observed differences.”
Fatima, E., Rehman, K. A., Rehman, O. U., Salih, N., Umer, M., Shah, M., Ghaffar, Q. B. A., Khalid, R., Rizvi, S. A. F. A., Qureshi, Z. A., et al. (2026) · Journal of Chemotherapy · doi:10.1080/1120009x.2026.2613189 · Cited by 1
Exploring the Landscape of HPV Vaccine Acceptability in Pakistan: A Systematic Review
Ali, P. A., Khalid, S. N., Memon, A., et al. (2025) · Journal of Rawalpindi Medical College · doi:10.37939/jrmc.v29i4.2937 · Cited by 1
Aldeyain, S. J., Alkhulaifi, N. S., Almutairi, F. M., et al. (2026) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_1750_25 · Cited by 1
“[2] Although these preventive measures were implemented in several countries, the prevalence of cervical cancer is expected to increase in the coming years Knowledge, attitudes and practice toward cervical cancer and its screening among women in Kuwait: A cross-sectional study due to the low…”
Lencha, B., Geda, B., Ahmed, K., et al. (2026) · BMC Family Practice · doi:10.1186/s12875-026-03303-8 · Cited by 1
Xu, M. A., Pant, S., & DiClemente, R. J. (2026) · Vaccine · doi:10.1016/j.vaccine.2026.128563 · Cited by 1
Zhou, Y., Liu, H., Pan, S., et al. (2026) · The FASEB Journal · doi:10.1096/fj.202504556rr · Cited by 1
“Despite notable progress achieved through vaccination and early screening programs, which have greatly reduced incidence in many regions, the disease still exerts substantial morbidity and mortality in developing and low-income countries where medical resources remain limited [3, 4].”
El‐Mesady, A., Abdelkawy, M. A., Farhan, M., & Izadi, M. (2026) · Mathematical Methods in the Applied Sciences · doi:10.1002/mma.70741 · Cited by 1
“The availability of licensed HPV vaccines [6] represents a significant advancement, though vaccine efficacy may be limited in established infections or certain population subgroups.”
Clinical research progress and challenges of vaccine for human papillomavirus-associated cancers
Xue, L., Li, X., Guo, X., Xing, H., & Liu, C. (2026) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2026.2676391 · Cited by 2
“114,115 Although prophylactic HPV vaccines have achieved significant success in preventing infections, several critical issues remain to be addressed, such as the limited protection spectrum and the financial barriers to vaccine access in LMICs.”
Global Cancer Prevention: Current Approaches and Future Directions
Adebamowo, C., Canfell, K., Adebamowo, S. N., et al. (2026) · American Society of Clinical Oncology Educational Book · doi:10.1200/edbk-26-519768 · Cited by 1
Self-citationLi, S. B., Tian, Y., Chen, C., et al. (2026) · iScience · doi:10.1016/j.isci.2026.115967 · Cited by 1
Xin, R., Gong, M., Guo, J., Tian, J., Wu, X., & Zhu, B. (2026) · Journal of Translational Medicine · doi:10.1186/s12967-026-08460-z · Cited by 2
“Therefore, improving the screening coverage rate not only involves increasing the participation rate of the “covered population”, but more importantly, extending screening services to countries and populations that have not been covered by the system [24].”
Alhetheli, G. I., Alhumaid, R., Alajlan, S., et al. (2026) · Vaccines · doi:10.3390/vaccines14060529 · Cited by 1
“This would enable medical students to better understand the HPV vaccination targets set by the WHO elimination strategy [9,10,14].”
Yu, J. S., Park, G., Seo, H., Kim, Y. H., & Kim, D. (2026) · Biomarker Research · doi:10.1186/s40364-026-00964-6 · Cited by 1
“The approval of the first prophylactic HPV vaccine in 2006 marked a major shift in primary prevention [2].”
The role of artificial intelligence in cancer epidemiology: Challenges and opportunities
Zhao, S., Yu, P., Xu, R., & Li, S. (2026) · Intelligent Oncology · doi:10.1016/j.intonc.2026.100070 · Cited by 2
Njue, J. K., Margaret, M. W., Kamau, L., & Lwembe, R. (2026) · IntechOpen eBooks · doi:10.5772/intechopen.1012871 · Cited by 1
Bonde, J. H., & Castle, P. E. (2026) · JNCI Monographs · doi:10.1093/jncimonographs/lgag010 · Cited by 1
Tuli, A., Jit, M., Abbas, K., & Portnoy, A. (2026) · BMJ Global Health · doi:10.1136/bmjgh-2025-021127 · Cited by 3
Self-citationAlmonte, M., Tejada, R. A., Calderón, A., & Baena, A. (2026) · JNCI Monographs · doi:10.1093/jncimonographs/lgag009 · Cited by 1
Printz, C. (2020) · Cancer · doi:10.1002/cncr.33070 · Cited by 1
Ouédraogo, L., Nkurunziza, T., Muriithi, A., Asmani, C., Elamin, H., Zan, S., Françoise, B., Belete, M., Gbénou, D., Kwami, D., et al. (2020) · Advances in Reproductive Sciences · doi:10.4236/arsci.2021.91005 · Cited by 1
Deciphering Pap Guidelines and Determining Management in Primary Care
Pfieffer, M. L., & Cross, L. (2021) · Advances in Family Practice Nursing · doi:10.1016/j.yfpn.2021.01.009 · Cited by 2
Chantziantoniou, N. (2022) · Acta Cytologica · doi:10.1159/000521911 · Cited by 1
Silva, I. D. A. G., de Sá, A. C. M. G. N., Prates, E. J. S., et al. (2022) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.6296.3835 · Cited by 1
“Pú bl ic a Brasil 49,2 (47,6;50,9) 1,6 (1,5;1,7)* 4,2 (3,4;4,9) 1,7 (1,3;2,2)* 7,3 (6,4;8,3) 0,7 (0,6;0,9)* 3,8 (3,1;4,4) 1,2 (0,9;1,5) 3,2 (2,5;3,8) 0,8 (0,7;1,1) 5,5 (4,6;6,4) 0,4 (0,3;0,4)* 25,4 (24;26,8) 0,7 (0,7;0,8)*”
BackgroundInfluentialRybicki, E. P. (2023) · Elsevier eBooks · doi:10.1016/b978-0-12-822784-8.00007-6 · Cited by 1
Rajaram, S., Sahoo, I., Heda, A., & SINGH, L. (2023) · Current Medicine Research and Practice · doi:10.4103/cmrp.cmrp_28_23 · Cited by 1
Current Methods and Advances in the Immunotherapy Treatment of Non-Ovarian Gynaecological Cancers
Adeleke, S. M., Gao, Y., Okoli, S., et al. (2023) · Future Pharmacology · doi:10.3390/futurepharmacol3020031 · Cited by 1
“It is anticipated to reduce the premature mortality rate of CC by one-third by 2030 and save the lives of more than 62 million women over the course of the next century [22,23].”
BackgroundNkounkou, R. B. B., Essangui, E., Foko, L. P. K., Nganga, C. P., Tsimba, P. C. L., Ntsiba, A. M. N., Boumba, L. M. A., Niama, F. R., & Moukoko, C. E. E. (2023) · Cancer Research Journal · doi:10.11648/j.crj.20231102.14 · Cited by 1
Purwar, S., Gupta, S., John, J. H., et al. (2023) · Journal of Mid-life Health · doi:10.4103/jmh.jmh_251_22 · Cited by 1
“[7] Studies have proved screening for HPV as an effective technique for protection against higher grades of cervical intraepithelial neoplasia (CIN).[8,9] HPV‐16 and 18 accounts for 70% of all cervical cancer cases.”
Shi, Z., Zhao, T., Zhang, J., et al. (2023) · Science of Advanced Materials · doi:10.1166/sam.2023.4463 · Cited by 1
CERVICAL CANCER IN THE WORLD (TRENDS, RISK FACTORS)
Ormonova, Z. A., Makieva, K., Макимбетов, Э. К., Toktanalieva, A. N., & Azhimamatova, Z. T. (2023) · Научное обозрение Медицинские науки (Scientific Review Medical Sciences) · doi:10.17513/srms.1352 · Cited by 4
Šmahel, M., & Nunvář, J. (2023) · Virology Journal · doi:10.1186/s12985-023-02241-6 · Cited by 1
“A significant reduction in HPV-driven carcinomas due to preventive vaccination is expected after 2050 [5].”
BackgroundCervical Cancer Burden in Nigeria: Review of Current Situation
Lawal Qudus, O., Lawal, I. K., Carter Cody, S., et al. (2023) · Gynecology & Reproductive Health · doi:10.33425/2639-9342.1211 · Cited by 1
“the first choice, however, other screening options include cytology as well as Visual Inspection with Acetic Acid/Lugol Iodine VIA/ VILI [4].”
Background(2023) · European Journal of Gynaecological Oncology · doi:10.22514/ejgo.2023.096 · Cited by 1
“ECM: extracellular matrix; TGF: transforming growth factor. was reported to play a pivotal role in its occurrence and progression [25–27].”
BackgroundVosoo, K., Sarli, A., Yousefi, Y., et al. (2023) · Cellular Molecular and Biomedical Reports · doi:10.55705/cmbr.2024.417181.1180 · Cited by 1
Xue, H., Chen, M., Li, S., et al. (2024) · Clinical and Experimental Obstetrics & Gynecology · doi:10.31083/j.ceog5106129 · Cited by 1
Peng, Q., Deng, Y., Li, G., Li, J., Zheng, P., Xiong, Q., Li, J., Chen, Y., & Ge, F. (2024) · Journal of Proteome Research · doi:10.1021/acs.jproteome.4c00349 · Cited by 1
The changing dynamics of cervical cancer screening and treatment in Papua New Guinea
Bolnga, J. W., & Bagita, M. R. (2024) · Papua New Guinea Medical Journal · doi:10.1071/mj21001 · Cited by 1
Odabaş, R. K., & Demir, R. (2024) · Kocaeli Üniversitesi Sağlık Bilimleri Dergisi · doi:10.30934/kusbed.1471350 · Cited by 1
Momodu, A., Ohenhen, J. E., Iyare, G. I., et al. (2024) · Discover Public Health · doi:10.1186/s12982-024-00319-2 · Cited by 1
“Understanding the interplay between HPV vaccination status and screening outcomes is imperative for refining cervical cancer prevention endeavors and tailoring screening guideline [10].”
Salibindla, D. B. A. M. R., & Jug, R. C. (2024) · Journal of the American Society of Cytopathology · doi:10.1016/j.jasc.2024.11.003 · Cited by 1
Ike, E. U., Nlemuwa, G. N., Gbadamosi, I. A., & Ndikom, C. M. (2025) · EMJ Reproductive Health · doi:10.33590/emjreprohealth/mxlc6000 · Cited by 1
Addressing gender disparities in France to advocate for women’s health equity
Ayoubi, J.-M., & Vallée, A. (2025) · Santé Publique · doi:10.3917/spub.251.0081 · Cited by 1
Liu, X., Zhang, S., Qiu, H., et al. (2025) · World Journal of Gastrointestinal Oncology · doi:10.4251/wjgo.v17.i4.102584 · Cited by 1
Cervical cancer in Asian countries: epidemiology, risk factors and challenges
Sultana, S. N., & Khatun, S. (2025) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20251429 · Cited by 1
Zhao, J., Li, W., Wang, Z., Liu, W. C., Sun, S., Wu, L., Du, S., Li, G., Pan, Z., Chen, D., et al. (2025) · The Oncologist · doi:10.1093/oncolo/oyaf197 · Cited by 1
“20,21 Participants undergoing opportunistic screening often differ demographically from those undergoing organized screening.”
Wang, G., Ching, C., Hanna, Y., Tandon, P., & Huang, V. (2025) · Digestive Diseases and Sciences · doi:10.1007/s10620-025-09199-1 · Cited by 1
“Most cases are preventable [79, 80] with effective primary and secondary prevention; that is, routine screening with Papanicolaou (Pap) smears and HPV vaccination (typically between 9 and 26 years of age).”
Macinas, D. V., Tantengco, O. A. G., de Paz‐Silava, S. L. M., et al. (2025) · American Journal of Reproductive Immunology · doi:10.1111/aji.70148 · Cited by 1
Alemany, L., & Brotons, M. (2025) · Vacunas · doi:10.1016/j.vacun.2025.500485 · Cited by 1
Ilić, I., Jakovljevic, V. L., Gajdács, M., Paulik, E., & Ilić, M. (2025) · Vaccines · doi:10.3390/vaccines13101001 · Cited by 1
“According to the WHO Cervical Cancer Elimination Modelling Consortium, high HPV vaccine coverage among girls can help avert 61 million cervical cancer cases across low-and middle-income countries and lead to the elimination of this disease in most of these countries over the next century [12].”
Kaur, A., Chawla, A., & Manjari, M. (2019) · AMEI's Current Trends in Diagnosis & Treatment · doi:10.5005/jp-journals-10055-0078 · Cited by 1
Moradi, S. (2020) · Evidence-Based Nursing · doi:10.1136/ebnurs-2020-103281 · Cited by 1
Kneitz, C. (2020) · DMW - Deutsche Medizinische Wochenschrift · doi:10.1055/a-1037-5256 · Cited by 1
Smith, J. P., Cao, H., Chen, W., et al. (2021) · Cancer Prevention Research · doi:10.1158/1940-6207.capr-20-0650 · Cited by 1
“Vaccinations targeted at preventing viral infections such as hepatitis B (3) and the human papillomavirus (4) have also significantly decreased the risk of hepatocellular and cervical cancer.”
BackgroundMeeting the challenges of cervical cancer screening and HPV vaccination in the UK
Westwood, R., & Lavery, J. P. (2021) · Primary Health Care · doi:10.7748/phc.2021.e1742 · Cited by 1
Garg, S., Shekhawat, U., Vohra, R., & Gupta, R. (2022) · The Journal of Obstetrics and Gynecology of India · doi:10.1007/s13224-022-01624-z · Cited by 1
Musaba, J., Mukosha, M., Mukololo, L., & Vwalika, B. (2021) · International Journal of Basic & Clinical Pharmacology · doi:10.18203/2319-2003.ijbcp20213359 · Cited by 1
“On the other hand, a study in Iran reported that increased serum Zn levels reduced the likelihood of UTIs.20 However, this study most likely reported different results to ours because of different factors.”
ResultInfluentialThe potential for further exploration of extramedullary spinal tumors in Iranian patients
Patel, A. B., & Lucke-Wold, B. P. (2023) · Cancer Research Statistics and Treatment · doi:10.4103/crst.crst_153_23 · Cited by 1
“graphic warning labels, or completely banning these products.[6] Another method of cervical cancer screening is the use of visual inspection with 3–5% acetic acid, an intervention that enables the screening and treatment of cervical cancer at low costs, as shown in Figure 1.”
MethodPolymorphism of KIR Genes in Women with Human Papillomavirus Infection
García, N. G. (2023) · Virology & Immunology Journal · doi:10.23880/vij-16000319 · Cited by 1
Cheang, C., Chan, W., Wang, X., & Xia, S. (2023) · Journal of Macau University of Science and Technology · doi:10.58664/mustjournal.2023.12.002 · Cited by 1
Rao, D. W., Bayer, C. J., Liu, G., Chikandiwa, A. T., Sharma, M., Tan, N., Mugo, N., & Barnabas, R. V. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3949428 · Cited by 1
Evidence of the Impact of Early Detection Programmes for Cancer
Hugtenburg, J. G., Pinedo, H. M., Blake, S. N., Bravio, I. G., Ljumanovic, R., & Beckeringh, J. J. (2022) · Springer eBooks · doi:10.1007/978-3-030-50247-8_125-1 · Cited by 1
Drolet, M., Laprise, J., Chamberland, É., Sauvageau, C., Wilson, S. E., Lim, G. H., Ogilvie, G. S., Tuite, A. R., & Brisson, M. (2024) · medRxiv · doi:10.1101/2024.05.29.24308112 · Cited by 1
Self-citationSang'udi, S. E., Muhunzi, D., Frank, W., Mzurikwao, D., Ngowi, J. E., Amani, D. E., Mnango, L. F., Mlole, A. T., Njiro, B. J., Kilasara, D., et al. (2025) · medRxiv · doi:10.1101/2025.03.09.25323636 · Cited by 1
Health and economic impact of the human papillomavirus (HPV) vaccine in MozambiquePreprint
Christen, P., Lima, A. V., Mintade, M., Torres, N. F., Hallett, T. B., Conteh, L., & Portnoy, A. (2025) · medRxiv · doi:10.1101/2025.06.17.25329752 · Cited by 1
Tuli, A., Jit, M., Abbas, K., et al. (2025) · medRxiv · doi:10.1101/2025.06.24.25330224 · Cited by 1
Self-citationEvidence of HPV vaccination efficacy comes from more than clinical trials
Sasieni, P. D., & Castañón, A. (2020) · Vaccine · doi:10.1016/j.vaccine.2020.06.080
“cervical cancer in various countries.[42] 139”
Kneitz, C. (2021) · Aktuelle Rheumatologie · doi:10.1055/a-1286-2520
“[14] Brisson M, Kim JJ, Canfell K et al.”
BackgroundThe principles and pitfalls of screening in primary care
Hutchinson, J. (2021) · InnovAiT Education and inspiration for general practice · doi:10.1177/17557380211021117
Essential medicine required for national SRHR guidelines implementation in Iraq
Al-Kinani, K. K. (2021) · Journal Of Advanced Pharmacy Education And Research · doi:10.51847/zlhkm64vln
Vaccination for Covid-19 and Human Papillomavirus: A Comparative Study
Sharma, J. K., Gupta, U., Nagaseshu, P., Kachroo, K., & Gopalan, G. (2022) · Acta Scientific Paediatrics · doi:10.31080/aspe.2022.05.0486
Understanding Covid-19 vaccines
Quaile, H. C., & Thompson, T. (2021) · Women’s Healthcare A Clinical Journal for NPs · doi:10.51256/whc042121
Human papillomavirus vaccine to prevent cervical cancer globally
(2020) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.14870
De, S. K. (2022) · doi:10.1002/9783527838561.ch8
Nirmala, K., Manjulatha, C., & Suseela, K. (2022) · International Journal of Health Sciences · doi:10.53730/ijhs.v6ns3.9262
“Cervical cancers began in the 20s, peaked in the 40s and 50s, and then fell until the age of 90, according to the current study shown in figure (2).”
Background
Metadata
- 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
- Brisson, Marc
- Kim, Jane J
- Canfell, Karen
- Drolet, Mélanie
- Gingras, Guillaume
- Burger, Emily A
- Martin, Dave
- Simms, Kate T
- Bénard, Élodie
- Boily, Marie-Claude
- Sy, Stephen
- Keane, Adam
- Caruana, Michael
- Nguyen, Diep T N
- Smith, Megan A
- Laprise, Jean-François
- Jit, Mark
- Alary, Michel
- Bray, Freddie
- Fidarova, Elena
- Broutet, Nathalie
- Hutubessy, Raymond
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2020-02
- Volume
- 395
- Issue
- 10224
- Pages
- 575-590
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- 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
- FWCI
- 70.75
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- 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.
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