HPV screening and vaccination accelerate cervical cancer decline

HPV screening, vaccination accelerate cervical cancer decline | Image Credit: © Leigh Prather - stock.adobe.com.

A new modeling study projects that South Korea could eliminate cervical cancer within the next 2 decades, with timelines varying based on screening methods and vaccination coverage. Findings published in JAMA Network Open demonstrate that adopting high-risk human papillomavirus (hrHPV) testing and increasing vaccination rates could accelerate elimination compared with current practices.¹

Globally, cervical cancer remains a significant health concern, with approximately 604,127 new cases reported in 2020 and more than 85% of cases occurring in lower-resource regions. The World Health Organization (WHO) has set an elimination target of fewer than 4 cases per 100,000 women, calling for 90% vaccination coverage of girls by age 15 years, 70% screening coverage by ages 35 and 45 years, and 90% treatment coverage for diagnosed cases.²

In South Korea, incidence has declined over the past two decades, dropping to 8 cases per 100,000 women in 2019. This reduction is attributed to the implementation of the National Cancer Screening Program in 1999, which provides biennial Papanicolaou (Pap) tests for women aged 20 years and older, and to the introduction of the HPV vaccination program in 2016. Vaccination coverage among 12-year-old girls reached approximately 74% by 2023.

Methods

Researchers constructed a deterministic, age-structured dynamic model to simulate HPV transmission, cervical cancer progression, and the effects of vaccination and screening in the Korean population from 2024 to 2100. The model incorporated sexual behavior data, demographic trends, and natural disease progression through stages of cervical intraepithelial neoplasia, leading to invasive cervical cancer.

The study evaluated 36 screening strategies, varying by test type (Pap or hrHPV), screening interval (2, 3, or 5 years), and age range. Two scenarios were modeled: a “realistic” scenario based on current screening participation (51.5%) and vaccination rates (75%), and an “ideal” scenario assuming 70% screening and 90% vaccination coverage beginning in 2030.

Results

Under the current biennial Pap test program, South Korea is projected to achieve cervical cancer elimination by 2044. Extending the Pap interval to 5 years delayed elimination by a decade or more, while 3-year Pap testing produced similar outcomes to the current strategy.

Switching to hrHPV testing substantially improved outcomes. Biennial hrHPV testing could reduce cervical cancer cases by 20% to 27% and deaths by 11% to 14% compared with current Pap-based strategies. Under realistic assumptions, elimination could occur as early as 2038 with hrHPV testing, while in the ideal scenario, elimination could be achieved by 2034.

The model further estimated that achieving 70% screening and 90% vaccination coverage from 2030 could prevent an additional 12% of cervical cancer cases and 7% of deaths by 2100. Sensitivity analyses showed that without the national HPV vaccination program, elimination could be delayed by up to 7 years, emphasizing the role of government-led immunization efforts.

Discussion

The investigators noted that “shifting to HPV-based screening has a greater impact on reducing cervical cancer incidence and mortality than merely increasing screening and HPV vaccination rates.” They added that HPV vaccination takes decades to influence incidence because cervical cancer typically arises later in life, while screening provides a more immediate reduction by detecting and removing precancerous lesions.

Global comparisons show that South Korea’s elimination timeline is earlier than projections for many other countries. For example, estimates for Malaysia predict elimination between 2056 and 2062, while US models suggest elimination between 2038 and 2046, depending on screening and vaccination coverage. Australia, which implemented early nationwide vaccination for both sexes, is projected to eliminate cervical cancer by 2028.

The authors acknowledged limitations, including the deterministic nature of the model, which does not capture individual-level variability, and the exclusion of co-infections with multiple HPV types. The study also did not incorporate economic evaluations, which would be relevant for assessing the cost-effectiveness of transitioning to hrHPV-based screening.

Conclusion

This modeling study suggests that South Korea could achieve cervical cancer elimination as early as 2034 with biennial hrHPV testing and high vaccination coverage. Under current policies, elimination is projected by 2044. The findings highlight the importance of integrating effective screening strategies with expanded vaccination programs to meet WHO elimination goals.

This article was originally published by our sister publication Contemporary Pediatrics.

References:

1. Luu XQ, Jun JK, Suh M, Oh J, Yu S, Choi KS. Cervical Cancer Screening, HPV Vaccination, and Cervical Cancer Elimination. JAMA Netw Open. 2025;8(8):e2526683. doi:10.1001/jamanetworkopen.2025.26683
2. World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. November 17, 2020. Accessed August 19, 2025. https://www.who.int/publications/i/item/9789240014107