The Age-Specific Cervical Cancer Incidence Differs Between Human Papillomavirus Types: Implications for Predicting the Impact of Elimination Programs.

The elimination of cervical cancer rests on high efficacy of Human Papillomavirus (HPV) vaccines. The HPV type distribution among Invasive Cervical Cancer (ICC) is used to make predictions about the impact of eliminating different HPV types, but accumulating evidence of differences in age-specific cancer incidence by HPV type exists. We used one of the largest population-based series of HPV genotyping of ICCs (n = 2,850; Sweden, 2002-2011) to estimate the age-specific ICC incidence by HPV type and provide estimates of the cancer-protective impact of the removal of different HPV types. In the base case, the age-specific ICC incidence had two peaks and the standardized lifetime risk (SLTR, the lifetime number of cases per birth cohort of 100,000 females) for HPV positive ICC was 651 per 100,000 female births. In the absence of vaccine types HPV16/18, the SLTR for ICC was reduced to 157 per 100,000 female births (24% of HPV+ SLTR). Elimination of all 9 types that can currently be vaccinated against reduced the remaining SLTR to 47 per 100,000 female births (7%), the remaining ICC incidence being only slowly increasing with age. In conclusion, very few ICC cases will be left, especially among fertile-aged women, after elimination of vaccine-protected HPV types.