The Revolution against cervical cancer is long since – but no one uses them

For a good ten years in Germany, vaccinations, cervical to prevent cancer. Now a study shows that such programs protect. However, the vaccination rate in this country is modest and experts criticize the programs for Tumor screening.

The world health organization (WHO) is aiming for an ambitious goal: the global elimination of cervical cancer, the fourth most common Tumor in women. Now is a great overview of the study attested that the project is feasible. Thus, the national vaccination programme against Human papilloma virus (HPV) lower in young women the risk for precursors to cervical cancer significantly.

In addition, unvaccinated groups of the population such as older women and men benefit from the so-called herd immunity. The extent of the protective effect depends, however, crucially from the respective vaccination programme, such as the international research team led by Mélanie Drolet of Université Laval in Quebec in the journal “The Lancet” reported.

“HPV is found in almost 100 percent of cases”

Human papilloma viruses are extremely widespread and can be transmitted during Sex. Some of the more than 200 known virus types cause harmless warts, and others cause more or less malignant changes in tissue, including cervix, vagina, Penis, Anus and in the mouth and throat area. Meanwhile, the viruses are considered to be the main cause of cervical cancer. “HPV is found in almost 100 percent of the cases of cervical cancer,” says Epidemiologist Drolet.

The Thomas Harder from the field Impfprävention at the Robert Koch-Institute (RKI) confirmed: “We know from basic research that the viruses are actually the cause of the tumors. That’s for sure.“ For his research in the field of the former head of the German cancer research center (DKFZ) in Heidelberg, Harald zur Hausen, 2008 winner of the Nobel prize for medicine. Getty Images/iStockphoto/Antonio Diaz , A woman is at the doctor to vaccinate

Variants 16 and 18 are especially dangerous

As dangerous is the HPV variants 16 and 18, which cause about 70 percent of all cases of cervical cancer are mainly. In Germany, about 4500 women in a cervical cancer, about 1500 die, are diagnosed per year, every year. Around the world, with approximately 570,000 cases per year, the fourth most common tumor Type in women, in the year 2018, more than 313.000 patients died. In addition, the virus-cause – men and women – rarer tumours about the Anus, Penis, as well as in the mouth and throat.

The HPV vaccination has been approved in Germany in 2007 and is now used in more than 100 countries and territories. It is recommended in Germany for girls and for boys from 9 to 14 years of age, preferably before the first Sex and were associated with a possible infection, as well as catch-up vaccination up to the age of 18. Birthday.

A study with 16 million people

A study by the Cochrane Collaboration showed a year ago that the vaccine reduces the individual risk of infection significantly: “The HPV vaccines reduce the risk for HPV16/18-related cancer precursor of 164 to 2 per 10,000 women,” wrote the network at the time. Information on severe side effects, the researchers found.

Now the Team of Drolet analyzed the impact of national vaccination programmes on population level. It appreciated 65 high-quality studies from 14 countries have been, including Germany. In total, until October 2018, published studies covered about 60 million people. The researchers compared the periods of time and after the introduction of vaccination, especially for three questions:

  • the development of HPV-infections
  • the diagnoses of anogenital warts (warts on the Anus and genitals)
  • the diagnoses of moderate precursors to serious Tumor (CIN2 ).

The results for the period of five to eight years after introduction of the vaccine:

  • Infections with HPV16 and HPV18 decreased in girls from 13 to 19 years, by an average of 83 per cent and for women from 20 to 24 years to 66 percent. In girls of 13 to 19 years, infections have decreased with the HPV-variants, 31, 33 and 45, a good half (54 percent).
  • The diagnosis of anogenital warts declined among girls 15 to 19 years of age by two-thirds (67 percent), women from 20 to 24 to one-third (31 percent) of boys of 15 to 19 and one-half (48 percent) and in men from 20 to 24 years, around a third (32 percent). Vaccination programmes have also those population groups that were not even vaccinated benefited accordingly.
  • The diagnoses of the tumor precursors, the degree of CIN2 declined among girls 15 to 19 years, half (51 percent) and women from 20 to 24 years, almost a third (31 percent).

The effect was due to thickness, however, the vaccination rate, and whether different year gears vaccinated. In countries with high vaccination coverage, the diagnoses of anogenital declined warts in both sexes at the age of 15 to 19 years by about 87 percent, the precursors of cervical cancer were diagnosed in 57 per cent less. In Germany, the vaccination is aimed at a relatively wide age group, vaccination rates among girls is, however, with about 45 percent modest.

“Our results provide strong evidence that the HPV can prevent vaccination actually cervical cancer, because HPV infections, which cause most of the tumors, as well as the precancerous lesions take”, is Drolet cited in a Lancet-release. The confirm the WHO recommendation to vaccinate girls aged 9 to 14 years. Getty Images/iStockphoto/noipornpan A woman at the doctor (the Icon)

No definitive proof

Although the study could not prove that the decline in infections and diagnoses goes back actually to the vaccination, admits the Team. This is very likely, since countries recorded higher vaccination coverage greater declines.

“This is the largest systematic review that investigated the impact of HPV vaccination on the population level”, says the RKI expert Harder. He also believes that the recorded protective effect is attributable to the vaccination programme.

“No one will doubt seriously”

This is also Ingrid Mühlhauser is from the German network for evidence-based medicine. How pronounced the effect is, however, difficult to say, says Mühlhauser, who teaches at the University of Hamburg, health Sciences. To be included in the study data from very different national vaccination programmes.

Moreover, the Numbers of infections and cancer were not precursors necessarily representative, since girls and young women were rarely investigated. “The study design is prone to bias,” she says. “However, I believe that the vaccination leads precursors to a reduction in the cancer. No one will doubt that seriously.“

Criticism of the procedure

In Germany, two HPV, according to Harder currently, vaccines that are approved – a is directed against the HPV variants 16 and 18, and the other against seven other HPV types. The vaccines are usually injected two Times in the period of at least five months. Serious side effects – so apart from the pain at the injection site, redness of the skin or the short-term circulatory problems are not known.

Is embedded the vaccination programme in Germany in the cervical cancer Screening. It Mühlhauser exerts sharp criticism. Currently, women from the age of 20 every year by a Pap smear to changes in cells to investigate – much too early and much too often, you will find it. Because changes are often spontaneous, would concern many women in the case of suspicious finding is unnecessary, and sometimes even treated. Getty Images/iStockphoto The female reproductive System (3D-graphics)

How often to the doctor?

Starting in January 2020, the programme is changing: women from 20 to 34 years will continue to get annual Pap Test, starting at 35, you should pull up to the age of 65 years every three years, a Pap and a HPV Test. Exaggerated the Mühlhauser place, especially as the vaccination is likely to lead to a significant waste of HPV infections.

For comparison, The WHO recommends, to examine women until the age of 30 years and then, in the case of normal findings in the interval of five years. That would be a total of 8 instead of in Germany by 2020 recommended 25 Tests. Evidence that more frequent Screening to reduce the risk of disease, there is, according to Mühlhäusler. “This often leads to over-diagnosis and Übertherapien to the detriment of many women,” she says.

“A Prime example for the prevention of cancer”

Positive is the expert rating of the new, Doctors must document that as of 2020 the results of the investigations. Thus, the Benefits of HPV vaccination could, in future, more reliable than previously determined.

The nationwide HPV vaccination rate among girls, from 45 percent of the RKI-expert Harder considers capable of improvement – in other areas, such as Scotland, up to 90 percent can be achieved. Vaccination rates could increase, if you offer the vaccine as part of School vaccination programmes, or invitation systems use, for example in the context of children and Youth screening.

The WHO’s goal of eliminating cervical cancer in the world, it holds Harder for the very ambitious, but achievable. But what about poorer countries? By 2021, nearly 40 such States wanted to hang up vaccination programmes, writes Silvia de Sanjose of the health organization PATH in Seattle in a “Lancet”comment. The present study would help the WHO, the HPV-Impfgrogramme throughout the world, she believes: “The HPV vaccination could be a Prime example for the prevention of cancer in the 21st century Century.“ The Weather Channel super cell happened to the German border Now threaten even tornadoes