The role of the human papillomavirus (HPV) vaccine in developing countries.

Cervical cancer is a preventable health problem, yet is the second most common cancer of women worldwide. More than 80% of cases occur in developing countries, and this is expected to increase to 90% by the year 2020. The five-year survival rate of patients in developing countries is less than 50%, compared to 66% in developed nations. A worldwide HPV vaccine program would significantly reduce the spread of HPV 16 and 18 and lower the incidence of cervical cancer. Mathematical models have determined that vaccinating 66% of the population will decrease the incidence of cervical cancer by 80% over the next 40-60 years. For every five-year delay in a cervical cancer prevention/detection program, there will be an additional 1.5-2.0 million deaths. The introduction of a vaccination program will be a challenge due to high costs, unknown durability of the vaccine, and the potential for new oncogenic strains to emerge. A global effort will be required to eliminate cervical cancer from developing counties.