MedicalResearch.com Interview with:
Dr. Tim Palmer
Honorary Senior Lecturer
Department of Pathology
University of Edinburgh
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: High risk HPV infection is the obligate cause of between 70 and 90% of cervical cancers, depending upon the country. The development of vaccines against the commonest hr-HPV types has the potential to reduce the burden of cervical cancer, especially in low and middle income countries that cannot afford screening programmes. Cervical cancer affects predominantly women in their 30s and is a major public health issue even in countries with well-established screening programmes. Scotland has had a successful immunisation programme since 2008, and women immunised at age 12 to13 have been screened since 2015. We can therefore demonstrate the effect of hr-HPV immunisation on the pre-invasive stages of cervical cancer.
MedicalResearch.com: What are the main findings?
Response: The results demonstrate that CIN3 – the effect of hr-HPV infection with the greatest risk of developing invasive cervical cancer, is reduced by 89% in women immunised at age 12 to 13, when compared to unimmunised women who were not eligible for the vaccine. This represents a massive reduction in disease. There is also less disease in women who decided not to be immunised at age 12 to 13, indicating the emergence of herd protection, but this is dependent upon maintaining high levels of vaccine uptake.
MedicalResearch.com: What should readers take away from your report?
Response: The vaccine used in Scotland – Cervarix – is highly effective. Giving the vaccine at age 12-13 years will protect women from getting the HPV infections that are most likely to lead to cervical cancer. The vaccine is safe, as in Scotland (as elsewhere) there have not been any serious side-effects where a link to immunisation can be demonstrated. The other HPV vaccines are also effective and safe, as shown by the many studies quoted in the paper. Vaccination will be more effective than screening at preventing women getting cervical cancer and is the only option in countries that cannot afford a screening programme.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The next stage is to see how effective the vaccine is at preventing disease from developing later in life. The study looks at women age 20, and in Scotland we have data on some immunised women who are now aged 28 or 29. We have begun looking at this data and are seeing reductions in disease in immunised women compared to non-immunised women. We are in the process of preparing this data for publication.
MedicalResearch.com: Is there anything else you would like to add?
Response: I have no conflicts of interest to disclose, and the data reported have been gathered as part of routine cervical screening activity. These data are very important as they demonstrate beyond reasonable doubt that HPV immunisation is effective and that the ideas put about the the vaccine does not work, or that HPV is ‘fighting back’ are wrong. The reductions in disease are much greater than was anticipated.
Palmer Tim, Wallace Lynn, Pollock Kevin G, Cuschieri Kate, Robertson Chris, Kavanagh Kim et al. Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study BMJ2019; 365 :l1161
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