Cervical Cancer Elimination in Scotland Expert Group Final Report

6. Assessment of the timeline for achieving cervical cancer elimination in Scotland ^[12]

Modelling of Scottish data, including cancer data, HPV vaccination rates, vaccine effectiveness estimates, and cervical screening coverage has been used to project the likely cervical cancer rates in future and how rates will vary by birth cohort over time. From this, the time at which cervical cancer is projected to fall below four new cases per 100,000 annually can be estimated for Scotland as a whole, and across different deprivation groups.

The modelling suggests that with current levels of HPV vaccination coverage and uptake of cervical screening, Scotland could be on track to eliminate cervical cancer as a public health problem within the next 25 years (2046-2050). However, projections indicate that whilst women residing in the least deprived areas will meet this target as early as 2036-2040, those residing in the most deprived areas, may not ever reach it with projections suggesting their rate will settle just above the 4 per 100,000 European Age Standardised Rate threshold. Some of this disparity is driven by the burden of existing disease in the older, more deprived women who have twice the initial cervical cancer incidence rates, for whom increased uptake of screening is of utmost importance. In younger women, the disparity is driven by the widening gap in HPV vaccination uptake between women residing in the most and least deprived areas. If the deprivation gap in both vaccination uptake and screening coverage continues to follow recent widening trends, then overall elimination is currently not predicted to occur until 2051-55 and in the most deprived areas the rate will settle above the target at around 5.7 per 100,000.

To achieve earlier elimination, higher HPV vaccine uptake and increased screening at all ages are needed, particularly in the most deprived groups. If the deprivation gap in vaccine uptake is eradicated - achieving the WHO target of 90% vaccine uptake - projected rates in the most deprived, decline to 3.8 per 100,000 by 2051-55 compared to 4.5 per 100,000 by 2061- 65 bringing forward elimination in this group by at least 10 years. To impact existing disease in older individuals, increasing screening coverage in the most deprived women (10% increase in SIMD 1 and 2) would reduce the disease rate to 4.3 per 100,000.

If there are aspirations to have elimination in Scotland as a whole by 2036-2040, this would require equitable vaccine uptake of 90%, equitable screening coverage of 90% and catch-up vaccination for a wider age range, with 90% uptake. This projects that those in the most deprived quintile would achieve a rate of 4.0 per 100,000 in 2041-45.