As Cervical Cancer Deaths Plummet, Experts Credit HPV Vaccine

FLORA LICHTMAN: This is Science Friday. I’m Flora Lichtman.

We’re starting the hour with some good vaccine news. A new study found that cervical cancer deaths in young women have plummeted since the introduction of the human papillomavirus vaccine. HPV is the most common sexually transmitted infection, and it can cause cancers of the mouth, throat, and sexual organs. It’s also the cause of nearly every case of cervical cancer. The vaccine for HPV was introduced in 2006. Now, almost 20 years later, cervical cancer deaths in young women are down 62%, and researchers say there is only one reason this could be, the HPV vaccine.

Joining me now to talk about this is Dr. Ashish Deshmukh, professor of public health sciences and coleader of the Cancer Prevention and Control Program at the Medical University of South Carolina in Charleston. Welcome to Science Friday.

ASHISH DESHMUKH: Thank you so much for having me.

FLORA LICHTMAN: Let’s talk about your study, Ashish. So just so I have my mind around it, your study looked specifically at women under 25. Is that right?

ASHISH DESHMUKH: Yes.

FLORA LICHTMAN: OK, and in that group, you are seeing this big drop in deaths from cervical cancer over the last decade or so, and that drop correlates to when you would expect to see a drop in deaths because of the introduction of the HPV vaccine. Is that right?

ASHISH DESHMUKH: That’s absolutely right because the way HPV vaccination works, it first prevents infections, HPV. We will then after observe decline in cervical cancer incidence rate and then drop in cervical cancer deaths.

FLORA LICHTMAN: Got it. OK, so this is a correlation study. Did you look at whether there are other possible explanations for why you see deaths from cervical cancer dropping?

ASHISH DESHMUKH: It’s unlikely because we know that sexual behaviors have not changed in the United States. We know that the three vaccination rates are increasing. We speculate that there are two possible reasons, both attributable to HPV vaccination. So individuals who received HPV vaccine, they are likely to have benefited. But in addition to that, there may be substantial herd protection attributable to HPV vaccination.

FLORA LICHTMAN: Did you see changes in cervical cancer rates or precancers as well?

ASHISH DESHMUKH: We did because in our previous research, we observed that. So the HPV vaccination was introduced in 2006, and our speculation or hypothesis for this study was that we will observe a decline in cervical-cancer deaths. And this hypothesis was driven by the fact that we published previous studies. A few years ago, we published another study in JAMA where we observed that among youngest age group, cervical-cancer incidence rate, or occurrence of new cases of cervical cancer, dropped 62%, again, 12% per year. And what we observed in this study is that the decline in mortality followed decline in incidence.

FLORA LICHTMAN: Tell me a little more about HPV. There are multiple strains, right?

ASHISH DESHMUKH: Yes. So it’s the most common sexually transmitted infection. There are more than 200 types of HPV, but types 16 and 18, they’re responsible for causing most cancer types.

FLORA LICHTMAN: And does the vaccine cover 16 and 18?

ASHISH DESHMUKH: It does. So the first iteration of vaccine, it covered HPV types 6, 11, 16, and 18, and the most recent version of the vaccine prevents nine HPV infection types.

FLORA LICHTMAN: Does the vaccine give you lifelong immunity?

ASHISH DESHMUKH: From what we have seen so far from the observational studies and studies from other countries is that, as a result of vaccination, there has been substantial decline. Now, lifelong immunity, it’s an area of current research. But again, our speculation is that it would prevent infection, at least causal infection over a substantial duration of time.

FLORA LICHTMAN: So your study looked at young women under 25, and the changes were profound, but we’re also talking about a relatively small group. I mean, the drop was from 50 to 60 deaths a year to 13. Is that right?

ASHISH DESHMUKH: Yes.

FLORA LICHTMAN: So when does cervical cancer usually onset in women?

ASHISH DESHMUKH: Sure. So cervical cancer is still fairly rare in this age group. The peak age at cervical cancer onset is among women who are in their 30s and 40s where most cases of cervical cancers are observed.

FLORA LICHTMAN: That’s interesting that it’s 30s and 40s. That seems still relatively young.

ASHISH DESHMUKH: It is. Cervical cancer is the type of HPV-associated cancers that occurs among young individuals.

FLORA LICHTMAN: When might we expect to have data on whether we’re going to see the same drops in cervical cancer in this older cohort?

ASHISH DESHMUKH: I think we’ll have to wait for at least 10 to 15 years, and what we speculate is that in future years, we will see even greater decline because the birth cohort as they age and the burden of HPV-associated cancer or the number of cases are higher in women who are in their 30s and 40s. So if the effect that we see persists in the consecutive age groups, we will see substantial drop in cervical and other HPV-associated cancers in the next 10 to 15 years.

FLORA LICHTMAN: Do you think that cervical cancer could be eradicated with this vaccine?

ASHISH DESHMUKH: It can. So there are two ways we can prevent cervical cancer through HPV vaccination. So we call it primary prevention or primary prophylaxis and screening for cervical cancer. So if we ensure that HPV vaccination rates are adequately achieved– we have a goal in front of us, 80% HPV vaccination coverage. And if we ensure that nearly all women are adherent to cervical-cancer screening guidelines, it’s possible that we completely eradicate HPV-associated cervical cancers.

FLORA LICHTMAN: That’s amazing.

ASHISH DESHMUKH: It is amazing, and I think what’s most amazing about cervical cancer and other HPV-associated malignancies is that these are types of cancers that are completely preventable through HPV vaccination. We have a vaccine that prevents against six cancer types. To me, it’s a public-health revolution.

FLORA LICHTMAN: I was going to say, are there other cancers that could be eradicated through vaccines, or is there something special about this group of HPV-related cancers?

ASHISH DESHMUKH: I think it’s special about HIV vaccination because of the fact that it’s infection-driven malignancy, and this is the only vaccine which has been shown to be highly efficacious for all six cancer types. It’s special about HPV vaccine that it has the potential to eliminate all six cancer types.

FLORA LICHTMAN: So you’ve been studying HPV and related cancers for many years. Why does this interest you?

ASHISH DESHMUKH: So I started studying HPV-associated malignancies since my doctorate days program. I went to my mentor, and he suggested, I have several projects, and one of those was focused on anal cancer. I was intrigued by anal cancer because I lost my grandmother to anal cancer. At that time, I had no idea that anal cancer is caused by HPV, and that’s how I got into HPV research.

FLORA LICHTMAN: Yeah, it’s personal.

ASHISH DESHMUKH: It is.

FLORA LICHTMAN: I was thinking, too, women’s health, as we know, has not, historically, been given as much attention. And, of course, these HPV cancers can affect both men and women, but for cervical cancer, obviously, only affects people with a cervix. And I was wondering if, for you, it was a conscious choice to spend your time on this when sometimes women’s health can be overlooked.

ASHISH DESHMUKH: It is, and it is area of major concern. I mean not just cervical cancer. If we look at HPV-associated anal cancer among women, it has been recognized as one of the fastest-rising causes of cancer incidence and mortality. Anal cancer is rising among women at 3% to 5% per year, and there there is nothing we can do except HPV vaccination. It is potentially preventable similar to cervical cancer, and we are trying our best to ensure that we identify ways to prevent anal cancer, again, both through primary prevention and secondary prevention. So I feel that for HPV-associated cancers and when we think of women’s health, it’s imperative that we focus on HPV-associated malignancies.

FLORA LICHTMAN: I remember when the HPV vaccine was rolled out in 2006. I was too old at the time to be eligible, but I remember distinctly some opposition, especially from parents because HPV is a sexually transmitted infection. And parents are like, well, my kids aren’t sexually active, so they don’t need this. Do you still encounter that mindset?

ASHISH DESHMUKH: We do. I think there is still a strong hesitancy toward HPV vaccination. And, again, I think this hesitancy is driven by the fact that the vaccine has been always perceived as something that prevents sexually transmitted infection. I think we need to change the way we talk about HPV vaccine and think of this as a cancer-prevention vaccine, an infection-prevention vaccine. I think that may help change parental perception.

But in our research, we do see substantial vaccine hesitancy. In fact, in one of our recent studies, we observed that among parents of unvaccinated adolescents, 60% still lack intent to initiate HPV vaccination, which is a major barrier in the US.

FLORA LICHTMAN: Wow. 60%. So it just needs a rebrand.

ASHISH DESHMUKH: Right.

FLORA LICHTMAN: How old can you be and get the HPV vaccine and have it still be effective?

ASHISH DESHMUKH: Sure. So the vaccine eligibility is up to age 45, and it is covered by insurance.

FLORA LICHTMAN: So we’ve been reading/seeing everywhere that childhood vaccination rates have been dropping since the COVID pandemic. Are we seeing the same thing with HPV?

ASHISH DESHMUKH: We are. So in the most recent birth cohort, HPV vaccination rates have dropped, and this drop is, I think, up to 4%. What we’re also observing is in the last three to four years, collectively, HPV vaccination rates have stagnated across age groups.

FLORA LICHTMAN: What about in other countries?

ASHISH DESHMUKH: So we don’t have similar evidence in other countries. I know in other developed nations, like Australia, vaccination rates have been high, and they have been able to achieve or are closer to achieving 80% vaccination goal.

FLORA LICHTMAN: Is that our goal too? what’s your goal? What do you want to see?

ASHISH DESHMUKH: So we need to ensure that we vaccinate all adolescents who are eligible.

FLORA LICHTMAN: 100% is your goal.

ASHISH DESHMUKH: 100% is our goal.

FLORA LICHTMAN: I’m going to give you Ira’s blank-check question. Ashish, if you had a blank check– you could do what you wanted. Resources were no issue. Where would you take your research? What would you do?

ASHISH DESHMUKH: So I ventured and try my best to ensure that both primary and secondary prevention is possible. There are several countries– India, China, for instance– where there’s substantial burden of cervical cancer, but we don’t have an adequate supply of HPV vaccination. Things are changing now in recent years. So, worldwide, I will ensure that HPV vaccination is adequately administered for cancers such as anal cancer. We don’t have screening infrastructure, which is a steep climb for us because it’s also driven by the fact that we don’t have enough providers who are adequately trained to perform anal-cancer screening. So if we have resources, we’ll ensure that the screening is available, particularly in communities that are marginalized underserved.

FLORA LICHTMAN: Ashish, thank you so much.

ASHISH DESHMUKH: Thanks a lot.

FLORA LICHTMAN: That’s about all the time we have for now. Dr. Ashish Deshmukh, professor of public health sciences and coleader of the Cancer Prevention and Control Program at the Medical University of South Carolina in Charleston.

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