How 30 years of research has halted HPV and cut cancer

Including a top 5 of the latest studies published in Papillomavirus Research that are contributing to ending HPV transmission

When a vaccine was released a decade ago against a common sexually transmitted virus, many people doubted how effective it would be. But ten years on, there has been a dramatic reduction in the circulation of the virus in vaccinated groups, and a reduction in associated cancers.

The virus, human papillomavirus or HPV, is the most common sexually transmitted infection; an estimated 79 million people in the US are infected with the virus. HPV causes cervical cancer, the second most common cancer in women globally; virtually all cervical cancer cases (99 percent) are linked to genital infection with HPV.

On 4 March 2018, the first International HPV Awareness Day was held to raise awareness of the virus, the associated cancers and celebrate the success of the vaccines that prevent its spread.

Developments in HPV research

It has been a long road leading up to the successful vaccines we have today. Thirty years ago, researchers like Dr. Xavier Bosch, editor-in-chief of the Elsevier journal Papillomavirus Research, were working to show that HPV causes cancer, and that the same types of HPV viruses causes cancer around the world. The impact has been significant, Dr. Bosch said:

By doing that, we opened a way for big pharma to invest heavily in the production of HPV diagnostics and HPV vaccines. In the last decade, we have been vaccinating worldwide. We can now confirm that the early expectations were in fact true; in populations that have been vaccinating girls intensively, within a decade, they have already shown a dramatic reduction in the circulation of the virus, which is very important for the young population, and the reduction of genital warts as well as the pre-invasive and invasive neoplastic disease. We are now in a position to show the world that by vaccinating entire cohorts, there is a very immediate effect in the reduction of the infection and the reduction of the disease.

The focus of the work now happening is on implementation – we know what works and it’s now about raising awareness of the importance of vaccination, and continuing to monitor its success around the world.

One way researchers and medical professionals are working to improve prevention is to widen the groups being vaccinated. The vaccines were first targeted at adolescent girls, in order to stop the spread of the virus and therefore the development of cervical cancer in young generations of women. Now, the vaccines are being made available to boys, to high risk groups such as people with immune suppression, and to middle-aged women. Dr. Bosch explained:

One of the critical findings in the recent years is that trials have shown that middle-aged adult women that are HPV negative and get vaccinated, they enjoy a protection almost as important as that which we obtain when vaccinating adolescent girls. There is now a fantastic opportunity to dramatically simplify the screening requirements by combining HPV screening and HPV vaccination in middle aged women.

Xavier Bosch
Editor-in-Chief Papillomavirus Research

Supporting today’s HPV research

Prevention efforts have been very successful so far, but there is still a lot of intervention needed. The HPV research field is currently producing some 3,000 papers a year. A lot of this research is on the effectiveness of the vaccines. Scientists are constantly working to improve their efficacy; the simplicity of use (such as lower number of doses, non-injection administration) and to reduce production costs. They are also developing vaccines with therapeutic properties, which could be offered to women who are already HPV infected.

With effective vaccines in place, there is also an increasing need for good screening methods. Intervention studies look at how good HPV testing, typing or the use of novel biomarkers  such as DNA methylation methods are, with the aim of replacing the Pap smear that has been the standard test for cervical cancer screening for over 60 years.

And there’s still a lot we don’t yet understand about the virus itself. Scientists are studying the mechanism by which HPV can induce cancer, and the way the virus like particles (VLPs) used in the vaccines are capable of generating such powerful immune responses that effectively block infection.

To have the greatest impact, this research has to be disseminated to the scientific community and beyond. Elsevier’s open access journal Papillomavirus Research, the official journal of the International Papillomavirus Society (IPVS), is the only one of its kind that focuses primarily on HPV research. For Dr. Bosch, the journal and the society are critical in the fight against HPV:

The Society is where HPV scientists gather and communicate. One of the expressions of this communication is the journal Papillomavirus Research, which gives the scientific community a way of communicating their results.

The journal plays a vital role in ensuring the quality of research being published – there is a group of expert editors, experts in their field, and a rigorous peer review process to make sure everything being published is contributing to the scientific knowledge base. And being open access, the journal also supports global access to research results – something that will be critical in the future as vaccination programs reach more developing countries.

We are now in a sort of gigantic web-based filing system in which you select keywords and retrieve the documents that you are after. Being open access has the advantage that every scientist in any country in the world can have access to the information.

Having been launched only a few years ago, the journal has also been indexed quickly – it gained Medline and PMC indexing in 2017 and has already achieved a high CiteScore and high ranking in two separate categories. All this helps increase the visibility of the HPV research being published, in turn supporting the advancement of our knowledge, and therefore prevention of HPV.

An HPV-free future?

On 4 March 2018, the first International HPV Awareness Day celebrated the strides made in HPV research and prevention, raised awareness of the virus and its associated cancers, and highlighted the research that’s still needed. As well as the campaign for the general public, ‘Give Love, Not HPV’, Dr. Bosch and his colleagues have also compiled a special issue of HPV World, which gives professionals an overview of the established evidence around HPV. The hope is that these physicians, nurses, midwives and many others will be better able to talk to patients and their families about HPV, as Dr. Xavier explained:

We know that in spite our 3,000 papers per year, many professionals have not read them. We have to update medical professionals to explain HPV prevention to hundreds of thousands of people in many different cultures: to the family that is worrying about vaccinating their children, to people who want HPV screening over and above the Pap smear, and to help people understanding what we can do if they are found as HPV positive. We know how to prevent several important cancers in men and women. People should be aware that these viruses exist, and that there are preventative opportunities.

The picture is a positive one: with the research being done , improvements to vaccine programs and the implementation of HPV based screening programs, Dr. Bosch believes we will see lower rates of infection and cancers in the coming years.

The expectation is that in the future, we will confirm to a larger scale that cervical cancer is going down, and with time we will show also that cancer of the vulva, vagina, anal cancer, cancer of the penis, and oropharyngeal cancers will all go down in vaccinated populations. The second major change that I envision is that the old Pap smear will give way to new strategies for HPV screening: instead of having to go every year for a Pap smear, women might go for screening every five years. Vaccinated cohorts may require even fewer screening events over lifetime without compromising safety. That will mean major savings for healthcare systems.

Research will continue, and with the support of the IPV Society and Papillomavirus Research, the results will have an impact. In the meantime, International HPV Awareness Day will play an important role in highlighting the topic, as Dr. Bosch commented:

We are very excited that by organizing International HPV Awareness Day, we will increase awareness in the general population by explaining that we have discovered this virus, that we know that the virus can cause cancer and that we have fantastic opportunities for prevention. This is a message that is extremely powerful and important today.

Top 5 of the latest studies published in Papillomavirus Research that are contributing to ending HPV transmission