HPV Vaccine: How close are we to wiping out cervical cancer?
Could a preteen vaccine wipe out a global cancer? In this episode, we examine the bold claim that cervical cancer could be eradicated in much of the world by the end of the century—thanks to the highly effective HPV vaccine. We unpack statistical modeling, microsimulations, and how Markov chains make good date-night conversation. We also explore why vaccine uptake has been uneven, how a splash of vinegar is helping screen for cancer in low-resource countries, and why HPV isn’t just a women’s issue—it now causes more cancer in men than in women. Plus: dangerously tight corsets, allegedly breast-squeezing nuns, and the Cosmo quote we wish we’d written ourselves.Statistical topics:Cancer surveillanceMarkov modelsMicrosimulation modelsSensitivity analysesPassive surveillanceBackground ratesCase reports and case seriesMethodologic morals:“When reality is too complex to test, let microsimulations do the rest.”“Case reports are medicine's equivalent to see something, say something. They call for hard data, not hysteria.”Citations:No cervical cancer cases detected in vaccinated women following HPV immunisation. University of Strathclyde, January 22, 2024.Palmer TJ, Kavanagh K, Cuschieri K, et al. Invasive cervical cancer incidence following bivalent human papillomavirus vaccination: a population-based observational study of age at immunization, dose, and deprivation. J Natl Cancer Inst. 2024;116:857-65.Rigoni-Stern. Statistical facts about cancers on which Doctor Rigoni-Stern based his contribution to the Surgeons' Subgroup of the IV Congress of the Italian Scientists on 23 September 1842. (translation). Stat Med. 1987;6:881-4.Gordan JA, Lenkei SC. Cleanliness, Continence, Constancy, and Cervical Carcinoma. Can Med Assoc J. 1964;90:1132.zur Hausen H. Condylomata acuminata and human genital cancer. Cancer Res. 1976;36:794.Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189:12-9.Chesson HW, Dunne EF, Hariri S, et al. The estimated lifetime probability of acquiring human papillomavirus in the United States. Sex Transm Dis. 2014;41:660-4.Sullivan, Morgan. Let’s Have a Little Chat About the HPV Vaccine. Cosmopolitan. March 19, 2025.Burger EA, Kim JJ, Sy S, et al. Age of Acquiring Causal Human Papillomavirus (HPV) Infections: Leveraging Simulation Models to Explore the Natural History of HPV-induced Cervical Cancer. Clin Infect Dis. 2017;65:893-99.Canfell K. Towards the global elimination of cervical cancer. Papillomavirus Res. 2019;8:100170.World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. November 17, 2020.Hall MT, Simms KT, Lew JB, et al. The projected timeframe until cervical cancer elimination in Australia: a modelling study. Lancet Public Health. 2019;4:e19-e27.Burger EA, Smith MA, Killen J, et al. Projected time to elimination of cervical cancer in the USA: a comparative modelling study. Lancet Public Health. 2020 Apr;5(4):e213-e222.Brisson M, Kim JJ, Canfell K, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395:575-90.Escabí-Wojna E, Alvelo-Fernández PM, Suárez E, et al. Sex differences in parental reasons for lack of intent to initiate HPV vaccination among adolescents ages 13-17 years: National Immunization Survey - Teen 2019-2021. Vaccine. 2025;44:126584. (see supplement) Szilagyi PG, Albertin CS, Gurfinkel D, et al. Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine. 2020;38:6027-6037.LaPook, Jonathan. Is the HPV Vaccine Safe? CBS Evening News. August 18, 2009.Slade BA, Leidel L, Vellozzi C, et al. Postlicensure safety surveillance for quadrivalent human papillomavirus recombinant vaccine. JAMA. 2009;302:750-7.Kharabsheh S, Al-Otoum H, Clements J, et al. Mass psychogenic illness following tetanus-diphtheria toxoid vaccination in Jordan. Bull World Health Organ. 2001;79:764-70.Jones TF, Craig AS, Hoy D, et al. Mass psychogenic illness attributed to toxic exposure at a high school. N Engl J Med. 2000;342:96-100.Buttery JP, Madin S, Crawford NW, et al. Mass psychogenic response to human papillomavirus vaccination. Med J Aust. 2008;189:261-2.Clements CJ. Gardasil and mass psychogenic illness. Aust N Z J Public Health. 2007;31:387.Simas C, Munoz N, Arregoces L, et al. HPV vaccine confidence and cases of mass psychogenic illness following immunization in Carmen de Bolivar, Colombia. Hum Vaccin Immunother. 2019;15:163-66.Larson HJ. Japan's HPV vaccine crisis: act now to avert cervical cancer cases and deaths. Lancet Public Health. 2020;5:e184-e185.Brinth LS, Pors K, Theibel AC, Mehlsen J. Orthostatic intolerance and postural tachycardia syndrome as suspected adverse effects of vaccination against human papilloma virus. Vaccine. 2015;33:2602-5.Large well-done studies following up on case reports and passive surveillance:Phillips A, Hickie M, Totterdell J, Brotherton J, Dey A, Hill R, Snelling T, Macartney K. Adverse events following HPV vaccination: 11 years of surveillance in Australia. Vaccine. 2020;38:6038-46.Arnheim-Dahlström L, Pasternak B, Svanström H, et al.
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