Primary Prevention of Cervical Cancer

Publication Date: March 17, 2017
Last Updated: December 16, 2022

In Maximal And Enhanced Resource Settings

Public health authorities, ministries of health, and primary care providers should routinely vaccinate girls with the target age range being as early as possible starting at 9 years through 14 years of age. ( EB , H , S )
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Public health authorities may set the upper end of the target population higher than 14 years of age, depending on local policies and resources. ( EB , L , M )
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For girls 9–14 years of age who are immune competent, a two-dose regimen is recommended. ( EB , I , M )
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least 6 months ( EB , H , S )
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may be up to 12–15 months (EB, L, W)
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Girls ≥15 years of age at the time of the first dose/initiation (outside of target population) who receive vaccine should receive three doses. ( IC , I , M )
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For females who have received one dose and are >14 years of age, public health authorities may provide additional doses/complete the series up to 26 years of age. ( EB , I , M )
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For prevention of cervical cancer, if there is low vaccine coverage of the priority female target population (<50%) in maximal or enhanced resource settings, then vaccination may be extended to boys. ( EB , I , M )
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For prevention of cervical cancer in maximal or enhanced resource settings where vaccine coverage of girls is ≥50%, then vaccination of boys is not recommended. ( EB , Ins, W )
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In Limited Resource Settings

Public health authorities, ministries of health, and primary care providers should vaccinate girls as early as possible, starting at 9 years through 14 years of age. ( EB , H , S )
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For girls starting at 9 years of age who are immune competent, a two dose regimen is recommended. (EB, I, M)
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at least 6 months ( EB , H , S )
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may be up to 12–15 months ( EB , L , M )
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If there are sufficient resources remaining after vaccinating high-priority populations with an adequate target (minimum recommended coverage is ≥50% with two doses, with a target of 80%), for females who have received one dose and are more than 14 years of age, public health authorities may provide additional doses/complete the series up to 26 years of age. ( EB , I , M )
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For prevention of cervical cancer in limited resource settings where vaccine coverage of girls is ≥50%, vaccination of boys is NOT recommended. For prevention of cervical cancer, if there is low vaccine coverage of the priority female target population (<50%) in limited resource settings, then vaccination may be extended to boys. ( EB , I , M )
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In Basic Settings

Public health authorities, ministries of health, and primary care providers should vaccinate girls in the priority target age group starting as early as possible through 14 years of age. ( EB , H , S )
614
For girls starting at 9 years of age who are immune competent, a two-dose regimen is recommended. ( EB , I , M )
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at least 6 months ( EB , H , S )
614
may be up to 12–15 months. ( EB , L , M )
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High coverage of priority populations should be emphasized. Where coverage of the primary targeted group of females is high (≥50%) and resources allow, the age group may be expanded upward in catch-up efforts. ( EB , H , S )
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For prevention of cervical cancer in basic resource settings where vaccine coverage of girls is ≥50%, vaccination of boys is NOT recommended. ( EB , I , M )
For prevention of cervical cancer, if there is low vaccine coverage of the priority female target population (<50%) in basic resource settings, then vaccination may be extended to boys.
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In All Resource Settings

Females who are HIV positive or immunosuppressed for other reasons should follow the same age recommendations but should receive three doses. ( EB , Ins, W )
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HPV vaccination is NOT recommended for pregnant women. ( EB , Ins, W )
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No vaccination strategy is recommended for women receiving treatment for cervical cancer precursor lesions (CIN2 ; eg, conization, loop electrosurgical excision process, cryotherapy). (, Ins, )

a Qualifying Statement for A4 and B4: Extending vaccination to boys to prevent cervical cancer is not cost-effective unless there is low vaccine coverage of the priority female target population (<50%). Vaccination may be extended to boys for other reasons, such as to prevent other noncervical HPV-related cancers and diseases (eg, genital warts) and/or to reduce circulating HPVs more rapidly.

b Qualifying Statement for C4: Extending vaccination to boys to prevent cervical cancer is not cost-effective unless there is low vaccine coverage of the priority female target population (<50%). However, if resources allow for efforts to reduce noncervical cancers and diseases and/or reduce circulating HPVs more rapidly, then vaccination may be extended to boys.

Additional Qualifying Statements: If boys are vaccinated, use the same age-related recommendations as for girls, according to resource settings. Recommendations regarding boys do not apply to men who have sex with men (MSM). Readers are referred to US CDC, Australian and other guidelines.

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Recommendation Grading

Overview

Title

Primary Prevention of Cervical Cancer

Authoring Organization

American Society of Clinical Oncology

Publication Month/Year

March 17, 2017

Last Updated Month/Year

October 2, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

To provide resource-stratified (four tiers), evidence-based recommendations on the primary prevention of cervical cancer globally.

Target Patient Population

General population

Target Provider Population

Public health authorities, cancer control professionals, policymakers, obstetricians and gynecologists, pediatricians

PICO Questions

What is the optimal method for primary prevention of cervical cancer in each resource stratum?

Inclusion Criteria

Female, Adolescent, Adult, Child

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Prevention

Keywords

primary prevention, prevention, cervical cancer

Source Citation

DOI: 10.1200/JGO.2016.008151 Journal of Global Oncology 3, no. 5 (October 01, 2017) 611-634.

Supplemental Methodology Resources

Data Supplement, Methodology Supplement

Methodology

Number of Source Documents
78
Literature Search Start Date
January 1, 2005
Literature Search End Date
June 20, 2015
Description of External Review Process
ASCO has a rigorous review process for guidelines. After the draft has been approved by the Expert Panel, the guideline is independently reviewed and approved by the Clinical Practice Guideline Oversight Committee (CPGC). Select members of the CPGC are asked to critically review the guideline prior to the next scheduled CPGC meeting. The CPGC members then present the results of their reviews to the full committee, discuss the review with the full committee, and the CPGC votes on whether to approve the guideline (with recusals from members who have relationships with affected companies). Approved ASCO Guidelines are then submitted to the Society’s journal for consideration of publication.
Specialties Involved
Family Medicine, Internal Medicine General, Obstetrics And Gynecology, Oncology
Description of Systematic Review
The Protocol specifies the purpose of the guideline product, target patient population, clinical outcomes of interest, key features of the systematic literature review, and a proposed timeline for completion. ASCO staff, the Expert Panel Co‐Chairs, and possibly other panel members selected by the Co‐Chairs (the Expert Panel Steering Committee), will typically draft the protocol for full panel review. A standard protocol worksheet is used for consistency. Once the Co‐Chairs have approved a first draft of the Protocol, the Protocol will be shared with the full Expert Panel. At the discretion of the Guidelines Director, the CPGC leadership and/or the CPGC Methodology Subcommittee may review the Protocol to make suggestions for revision intended to clarify aspects of the plan for developing the guideline. These suggestions are sent to the Expert Panel Co‐Chairs. Work on the systematic literature review can proceed upon the sign‐off of the Protocol by the Expert Panel.
List of Questions
See Full Text.
Description of Study Criteria
See Supplement.
Description of Search Strategy
Upon approval of the Protocol, a systematic review of the medical literature is conducted. ASCO staff use the information entered into the Protocol, including the clinical questions, inclusion/exclusion criteria for qualified studies, search terms/phrases, and range of study dates, to perform the systematic review. Literature searches of selected databases, including The Cochrane Library and Medline (via PubMed) are performed. Working with the Expert Panel, ASCO staff complete screening of the abstracts and full text articles to determine eligibility for inclusion in the systematic review of the evidence. Unpublished data from meeting abstracts are not generally used as part of normal ASCO guideline development (“Meeting Data”). However, abstract data from reputable scientific meetings and congresses may be included on a case‐by‐case basis after review by the CPGC leadership. Expert Panels should present a rationale to support integration of abstract data into a guideline. The CPGC leadership will consider the following inclusion criteria for the unpublished scientific meeting data: 1) whether the data were independently peer reviewed in connection with a reputable scientific meeting or congress; 2) the potential clinical impact of the unpublished data; 3) the methodological quality and validity of the associated study; 3) the potential harms of not including the data; and 4) the availability of other published data to inform the guideline recommendations.
Description of Study Selection
Literature search results were reviewed and deemed appropriate for full text review by two ASCO staff reviewers in consultation with the Expert Panel Co-Chairs. Data were extracted by two staff reviewers and subsequently checked for accuracy through an audit of the data by another ASCO staff member. Disagreements were resolved through discussion and consultation with the Co-Chairs if necessary. Evidence tables are provided in the manuscript and/or in Data Supplement.
Description of Evidence Analysis Methods
ASCO guideline recommendations are crafted, in part, using the GuideLines Into DEcision Support (GLIDES) methodology. ASCO adopted a five‐step approach to carry out quality appraisal, strength of evidence ratings and strength of recommendations ratings. The ASCO approach was primarily adapted from those developed by the AHRQ,, USPSTF, and GRADE, however with the validation of the GRADE methodology, the sole use of GRADE is being evaluated by the Clinical Practice Guidelines Committee.
Description of Evidence Grading
High: High confidence that the available evidence reflects the true magnitude and direction of the net effect (i.e., balance of benefits v harms) and that further research is very unlikely to change either the magnitude or direction of this net effect. Intermediate: Moderate confidence that the available evidence reflects the true magnitude and direction of the net effect. Further research is unlikely to alter the direction of the net effect; however, it might alter the magnitude of the net effect. Low: Low confidence that the available evidence reflects the true magnitude and direction of the net effect. Further research may change either the magnitude and/or direction this net effect. Insufficient: Evidence is insufficient to discern the true magnitude and direction of the net effect. Further research may better inform the topic. The use of the consensus opinion of experts is reasonable to inform outcomes related to the topic.
Description of Recommendation Grading
ASCO uses a formal consensus methodology based on the modified Delphi technique in clinically important areas where there is limited evidence or a lack of high‐quality evidence to inform clinical guidance recommendations. Evidence Based: There was sufficient evidence from published studies to inform a recommendation to guide clinical practice. Formal Consensus: The available evidence was deemed insufficient to inform a recommendation to guide clinical practice. Therefore, the Expert Panel used a formal consensus process to reach this recommendation, which is considered the best current guidance for practice. The Panel may choose to provide a rating for the strength of the recommendation (i.e., "strong," "moderate," or "weak"). The results of the formal consensus process are summarized in the guideline and reported in the Data Supplement (see the Supporting Documents" field). Informal Consensus: The available evidence was deemed insufficient to inform a recommendation to guide clinical practice. The recommendation is considered the best current guidance for practice, based on informal consensus of the Expert Panel. The Panel agreed that a formal consensus process was not necessary for reasons described in the literature review and discussion. The Panel may choose to provide a rating for the strength of the recommendation (i.e., "strong," "moderate," or "weak"). No recommendation: There is insufficient evidence, confidence, or agreement to provide a recommendation to guide clinical practice at this time. The Panel deemed the available evidence as insufficient and concluded it was unlikely that a formal consensus process would achieve the level of agreement needed for a recommendation.
Description of Funding Source
ASCO provides funding for Guideline Development.
Company/Author Disclosures
ASCO Conflict of Interest Policy complies with the CMSS Code for Interactions with Companies. ASCO requires disclosure by individuals involved in drafting, reviewing, and approving guideline recommendations.
Percentage of Authors Reporting COI
100