The American Society of Clinical Oncology (ASCO) has recently issued a clinical practice guideline for the HPV vaccine for the primary prevention of cervical cancer; a guideline that is adapted for multiple regions of the world with differing socio-economic statuses and structural resource settings.
The new ASCO release is the first to take this global stance in primary prevention of cervical cancer and to offer evidence-based guidance to health care providers worldwide. The report provides prevention recommendations stratified for four defined resource settings: basic, limited, enhanced and maximal.
Within this stratification, countries and regions are defined by their financial resources, as well as the development of health systems, inclusive of personnel, infrastructure and access to services.
In all environments, regardless of the resource settings, the guideline states that two doses of the HPV vaccine are recommended for girls aged 9–14 years, with an interval of at least 6 months and up to 12–15 months between doses. It is also recommended that HIV-positive girls should receive three doses of the vaccine.
For individuals above the age of 14 years of age in maximal and enhanced resource setting, the guideline states that:
- If girls are 15 years or older and have received their first dose before age 15, they may complete the two-dose series
- If they have not received the first dose before age 15, they should receive three doses
- In both scenarios vaccination may be given through age 26 years
For this population in the limited and basic resource settings, the report states: if sufficient resources remain after vaccinating girls 9–14 years, girls who received one dose may receive additional doses between ages 15–26 years.
In terms of the vaccination of boys, the ASCO report suggests that in all settings, boys may be vaccinated as long as there is at least a 50% coverage in priority female target population, sufficient resources, and vaccination is cost-effective.
The ASCO guideline is the result of a collaborative effort between a multinational and multidisciplinary panel of oncology, obstetrics/gynecology, public health, cancer control, epidemiology/biostatistics, health economics, behavioral/implementation science, and patient advocacy experts.
“Because resource availability varies widely, both among and within countries, we need to adjust strategies to improve access to HPV vaccination everywhere,” commented Silvia de Sanjosé, co-chair of the Expert Panel that developed the guideline (Institut Català d’Oncologia, Barcelona, Spain). “This guideline is unique in offering cervical cancer vaccination recommendations that can be adapted to different resource levels and we expect it to have a major impact on the global health community.”