Primary Prevention of Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Guideline.

Purpose: To provide resource-stratified (four tiers), evidence-based recommendations on the primary prevention of cervical cancer globally.
Methods: The American Society of Clinical Oncology convened a multidisciplinary, multinational panel of oncology, obstetrics/gynecology, public health, cancer control, epidemiology/biostatistics, health economics, behavioral/implementation science, and patient advocacy experts. The Expert Panel reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus-based process with additional experts (consensus ratings group) for one round of formal ratings.
Results: Existing sets of guidelines from five guideline developers were identified and reviewed; adapted recommendations formed the evidence base. Five systematic reviews, along with cost-effectiveness analyses, provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75%.
Recommendations: In all resource settings, two doses of human papillomavirus vaccine are recommended for girls age 9 to 14 years, with an interval of at least 6 months and possibly up to 12 to 15 months. Individuals with HIV positivity should receive three doses. Maximal and enhanced settings: if girls are age ≥ 15 years and received their first dose before age 15 years, they may complete the series; if no doses were received before age 15 years, three doses should be administered; in both scenarios, vaccination may be through age 26 years. Limited and basic settings: if sufficient resources remain after vaccinating girls age 9 to 14 years, girls who received one dose may receive additional doses between age 15 and 26 years. Maximal, enhanced, and limited settings: if ≥ 50% coverage in the priority female target population, sufficient resources, and cost effectiveness, boys may be vaccinated to prevent other noncervical human papillomavirus-related cancers and diseases. Basic settings: vaccinating boys is not recommended.
It is the view of the American Society of Clinical Oncology that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
Competing Interests: The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc. Silvina ArrossiNo relationship to discloseSarah TeminNo relationship to discloseSuzanne GarlandLeadership: Merck Sharp & Dohme, CSL, GlaxoSmithKline Honoraria: Sanofi Pasteur, HPV standalone scientific symposium Barcelona 2014, lectures and media interviews on HPV best practices in Australia and Japan 2014, International Gynecological Cancer Society, Merck Sharp & Dohme, Merck Consulting or Advisory Role: Merck Sharp & Dohme Research Funding: Merck Sharp & Dohme (Inst), CSL (Inst), GlaxoSmithKline (Inst) Travel, Accommodations, Expenses: Merck Sharp & Dohme, Pan American Health Organization/WHO, GlaxoSmithKlineLinda O’Neal EckertNo relationship to discloseNeerja BhatlaResearch Funding: Merck Sharp & DohmeXavier CastellsaguéNo relationship to discloseSharifa Ezat AlkaffNo relationship to discloseTamika FelderHonoraria: Quest Diagnostics, Genentech, Merck, HologicDoudja HammoudaTravel, Accommodations, Expenses: MerckRyo KonnoHonoraria: GlaxoSmithKline, Merck Sharp & Dohme, Qiagen, Roche, Chugai Pharmaceutical Consulting or Advisory Role: GlaxoSmithKline, Merck Sharp & Dohme Research Funding: Chugai Pharmaceutical (Inst)Gilberto LopesHonoraria: AstraZeneca, Roche, Merck Serono, Merck Sharp & Dohme, Fresenius Kabi, Novartis, Bristol-Myers Squibb, Janssen-Cilag, Boehringer Ingelheim, Pfizer, Cipla, Sanofi, Eisai, Eli Lilly Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, Eli Lilly Research Funding: Eli Lilly, Pfizer, AstraZeneca, Merck Sharp & Dohme, Eisai, Bristol-Myers Squibb Expert Testimony: SanofiEmmanuel MugishaNo relationship to discloseRaul MurilloNo relationship to discloseIsabel C. ScarinciNo relationship to discloseMargaret StanleyHonoraria: Merck Sharp & Dohme Consulting or Advisory Role: GlaxoSmithKlineVivien TsuNo relationship to discloseCosette M. WheelerResearch Funding: GlaxoSmithKline (Inst), Roche (Inst)Isaac Folorunso AdewoleHonoraria: GlaxoSmithKlineSilvia de SanjoseResearch Funding: Merck (Inst), GlaxoSmithKline (Inst)