Summary and Conclusions
SBU’s appraisal of the evidence: Vaccination against viral infections is a relatively new principle for cancer prevention. Vaccines against human papilloma virus (HPV) are aimed at preventing cervical cancer. Current vaccines target HPV types 16 and 18 and not all cervical cancer-associated HPV types.
In young women1 showing no signs of past or current HPV 16 or 18 infection at the onset of the study, vaccination provided over 90% protection against high-grade cervical intraepithelial neoplasias (CIN) positive for HPV 16 or 182 (Evidence Grade 1)*. These study results currently offer the closest estimate of the expected preventive effect of vaccinating children.
After vaccination, children initially developed an immune response that was equal or superior to that achieved in young women after vaccination2 (Evidence Grade 2)*.
The effect of general childhood vaccination against HPV 16 and 18 on future morbidity and mortality from cervical cancer in Sweden is not yet known. One estimate shows that nearly half of the cervical cancer cases would not be prevented by general childhood vaccination against HPV 16 and 18. Therefore organized cervical cancer screening programs would need to continue.
The effect of general childhood vaccination against HPV 16 and 18 on the willingness of vaccinated women to participate in organized screening programs would need to be determined.
Scientific evidence on the cost-effectiveness of general childhood vaccination against HPV 16 and 18, in combination with organized cervical cancer screening programs, is uncertain and therefore found to be insufficient. Whether or not vaccine against HPV 16 and 18 should be included in the Swedish general vaccination program is a policy issue that concerns, among other things, the level of uncertainty that the public can accept regarding positive and negative effects when allocating resources. Introducing such a program would require organized, systematic followup of the outcomes and cost-effectiveness of all preventive interventions against cervical cancer.
