Eliminating Cervical Cancer: The Importance of HPV Vaccination and Screening in China

As the only cancer with a clear cause, preventable and controllable, cervical cancer may become the first cancer to be eliminated in the world?

With the release of the World Health Organization’s “Global Strategy to Accelerate the Elimination of Cervical Cancer”, this inference is being recognized by more and more countries, among which Australia has benefited from the application of HPV vaccine and the active promotion of cervical cancer screening. It is planned to eliminate cervical cancer by 2035. At the same time, my country seems to have a long way to go to achieve this goal, and there is a long way to go to eliminate cervical cancer. Judging from the monitoring data of tumor registration every year, the incidence and mortality of cervical cancer in my country have been increasing in the past 20 years. The rise of the disease not only brings great harm to the body and mind of many female patients, but also brings a huge economic burden to the family.

In this regard, Professor Zhao Fanghui, director of the Epidemiology Research Office of the National Cancer Center and the Cancer Hospital of the Chinese Academy of Medical Sciences, said that the key to eliminating cervical cancer is to move the prevention barrier forward and increase the initial investment, among which HPV vaccination + cervical cancer screening is especially important. The key to the key. However, the coverage of cervical cancer screening and vaccination in my country is still not enough.

This point of view also coincides with the first “Investigation on HPV Vaccine Consumption Behavior” (hereinafter referred to as the “Survey”) announced by the 21st Century Business Herald and the 21st Century New Health Research Institute. With the vigorous promotion of HPV vaccines, the awareness rate of HPV vaccines in my country continues to rise, and women of appropriate age have a high willingness to vaccinate HPV vaccines. “Pain points such as vaccine hesitation and waiting have formed, and the actual vaccination rate is still not high.

For this reason, it is particularly important to help school-age women correctly understand the value of HPV vaccine, which not only includes the value of life, but also the economic value to individuals, families and society.

The social value of HPV vaccine: preventing diseases and improving residents’ health index

According to the statistics of the World Health Organization (WHO), there will be about 110,000 new cases of cervical cancer in my country in 2020, and about 59,000 deaths. This is equivalent to a woman being diagnosed with cervical cancer every 5 minutes, and a woman dying of cervical cancer every 9 minutes.[1]This also makes my country the second largest country with the burden of cervical cancer disease in the world after India.

To this end, at the beginning of this year, the National Health Commission, the Ministry of Education, the Ministry of Civil Affairs, the Ministry of Finance and other ten departments jointly formulated and issued the “Action Plan for Accelerating the Elimination of Cervical Cancer (2023-2030)”, clearly through HPV vaccination, screening The tertiary preventive measures such as treatment and treatment can effectively prevent and control cervical cancer and eventually eliminate it. As the first line of defense, HPV vaccination is also a key area of ​​national investment. In addition to actively strengthening the scientific publicity of HPV vaccination and promoting the pilot work of HPV vaccination, it has also started or announced that it will be carried out in many provinces and cities. HPV vaccination program to increase HPV vaccination rates among school-age girls.

Professor Fang Ya from the School of Public Health of Xiamen University pointed out that some studies have established mathematical models to show that if we increase investment in prevention and control, optimize prevention and control strategies, and increase HPV vaccine coverage and cervical cancer screening rates as much as possible, the estimated As soon as 2047, the age-standardized incidence of cervical cancer in my country will drop to 4/100,000, that is, to achieve the WHO strategic goal of eliminating cervical cancer, and in the next 80 years, China will reduce health expenditure by more than 100 billion U.S. dollars and avoid 7.5 million cervical cancers. cancer cases and 2.5 million cervical cancer deaths.

Professor Zhao Fanghui also emphasized that vaccination of women of the right age will help prevent the spread of HPV among the population, increase potential beneficiaries, and ultimately effectively improve people’s health index. In addition, the HPV vaccine is a preventive vaccine, and the best effect is to get it before the virus infection occurs. Especially in the 9-14-year-old adolescent female group, the immune response is better, and the cost-effectiveness after vaccination is better. Relevant data also show that younger women are better protected by HPV vaccination. Therefore, from the perspective of the whole society, it is of great significance to keep her from infection in the age group with the best investment and the best results.

The family value of HPV vaccine: Effectively reduce the cost of family medical treatment and build a strong family health barrier

As the only vaccine that can prevent cancer in the world, the value brought by HPV vaccine is not only to reduce the incidence of disease, but also has a very intuitive impact on a family. However, according to this survey, only 37.1% of the respondents realize the impact of HPV vaccine on the value of the family.

In this regard, Professor Fang Ya said: “In recent years, the employment rate of women in my country has continued to increase, which means that their contribution to the family economy is also gradually increasing. At the same time, women still bear the main responsibility of family care in the family. Therefore, through Vaccination can reduce the incidence of diseases such as cervical cancer, which can not only reduce medical expenses, but also reduce the economic burden of patients’ families.”

“After females in the family are vaccinated against HPV, they will provide males with indirect protection. When the vaccine coverage rate in society is high, herd immunity can be formed in the population, providing indirect protection for unvaccinated populations,” Professor Fang added. According to epidemiological studies of cervical cancer, there are two peak periods of high-risk HPV infection among women in my country. The first peak period is between 15 and 24 years old, and the second peak period is over 40 years old. Therefore, it is recommended that mothers and daughters who meet the vaccination requirements co-vaccinate can build a health protection barrier for the family.

What’s more worth mentioning is that the domestically approved bivalent HPV vaccines (including imported and domestic) only need two injections for women aged 9-14, which simplifies the vaccination procedure on the premise of effective disease prevention. Reduce the cost of vaccination by about one-third. For families of young vaccinators, it can also reduce the manpower, material and financial costs caused by one vaccination.

The individual value of HPV vaccine: cancer prevention should be reduced, and the vaccine is more cost-effective

Studies have shown that the total cost of cervical cancer in China is 58,189-79,567 yuan per case in the first year, and 13,025-27,965 yuan per case per year thereafter. It can be seen that it is particularly important to shift expenditures inside and outside the medical system to prevention. After all, prevention is usually less expensive than treatment, and can lead to higher financial returns by reducing the need for more expensive treatments later. However, in this “Survey”, there are still some women interviewed who do not know about the HPV vaccine and have no vaccination plan for the time being.

In this regard, Professor Fang Ya said: “The health benefits of HPV vaccination are greater than the cost of vaccination. Studies have shown that bivalent vaccines require the least cost for every additional quality-adjusted life year, and the net monetary benefits obtained Relatively larger, that is, the difference between the cost of disease avoided after vaccination and the cost of vaccination is relatively larger.” In other words, compared with high-priced vaccines, the bivalent HPV vaccine only costs less than half of the vaccination cost, but protects against Most cervical cancers are extremely cost-effective investments.

And such a cost-effective health investment is gradually becoming the choice of more people-according to the “Research”, in the face of the price range of several hundred to 5,6 thousand yuan, nearly 70% of the interviewed women are taking HPV vaccine When choosing, priority will be given to the relatively more cost-effective 1-3 thousand gears, that is, “gaining higher benefits through moderate expenditure”. Compared with those who have been vaccinated, the unvaccinated population has significantly reduced their budget, and the proportion willing to spend more than 2,000 yuan has decreased by 11.6%. It can also be said that in today’s more “lean” attitude towards spending money, the quality and price ratio of vaccines may become the first factor affecting the audience’s choice.

It is true that Chinese school-age women have more choices. There are 5 kinds of HPV vaccines to choose from, including imported bivalent, quadrivalent, and 9-valent vaccines, and 2 domestically produced bivalent vaccines. However, Professor Zhao Fanghui pointed out that the bivalent, quadrivalent, and nine-valent vaccines sound like the numbers are very different, but the actual protective effect is not much different. For example, for the prevention of cervical cancer, the bivalent HPV vaccine contains two very important high-risk types, one is HPV16 and the other is HPV18. In China, 84.5% of cervical squamous cell carcinomas are caused by these two high-risk types. , bivalent HPV vaccine has been able to prevent most cervical cancer and precancerous lesions.

In addition, during the survey, more than 95% of the interviewed women are willing to wait for the vaccine they intend to vaccinate, and only 20% of them are aware of the health risks while waiting, and younger women are more likely to ignore this risk.

In response to this phenomenon, Professor Zhao Fanghui said: “In terms of vaccine selection, the most critical issue is the availability of vaccines. When high-priced vaccines are in short supply, vaccinators may have to wait for 1-3 years. At this stage, There will be a risk of immune gaps. However, if you choose a bivalent HPV vaccine with sufficient supply, you can immediately achieve protection against 70%-80% of cervical cancer. Therefore, now we recommend that you get any vaccine available, and do not wait for a long time. “

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责编：李然 ]