NHS 70 research discoveries: Manchester leads pioneering work into HPV vaccine and testing for cervical cancer in the early 2000s
In the seven week run-up to the 70th birthday of the NHS, we will highlight a different research discovery from Manchester University NHS Foundation Trust each week from the past 70 years.
Week 3 – Manchester leads pioneering work into HPV vaccine and testing for cervical cancer
Cervical cancer causes 250,000 deaths every year worldwide. Cervical screening prevents cervical cancer by detecting and treating pre-malignant disease, and this has more than halved deaths from cervical cancer in England since the late 1980’s when organised screening began.
It was around that time that scientists discovered that cervical cancer is caused by sexually transmitted infection with human papillomavirus (HPV). This discovery led to the exciting possibility that vaccines could be developed to prevent and treat HPV infection and thus reduce the burden of cervical cancer across the world. It also enabled screening to include testing for the HPV infection, rather than the later stage development of the pre-malignant disease. In 2001, pioneering studies began at Manchester University NHS Foundation Trust that made a major contribution to the global effort to control cervical cancer.
The earliest trials (2001-2005) were led by Henry Kitchener, Professor of Gynaecological Cancer at Saint Mary’s Hospital and Peter Stern, a Cancer Research UK (CRUK) scientist working in the CRUK Manchester Institute. A prototype HPV vaccine developed by CRUK was first given in a phase 1 trial to women with cervical abnormalities at Saint Mary’s Hospital. This and subsequent phase 2 trials showed that these vaccines could stimulate the immune system to prevent HPV infection, but treating established infection proved a much tougher challenge.
A new vaccine was developed by the pharmaceutical company, GSK. Known as Cervarix, this targeted HPV types 16 and 18, which together are responsible for 70% of cervical cancers worldwide. Saint Mary’s Hospital was the lead site in the UK for a pivotal global trial of 15-26 year old women. It proved beyond doubt that the vaccine was almost 100% effective at preventing precancerous lesions caused by HPV 16/18. Following publication of this trial in the Lancet (2007;369:2161-70), the UK government funded a national HPV vaccination programme for 12 year old girls, which has achieved very high coverage, and is already resulting in a massive reduction in the prevalence of HPV infection.
Another major trial was led from Saint Mary’s Hospital in collaboration with Mina Desai in the Manchester Cytology Centre, and Julian Peto of the London School of Hygiene and Tropical Medicine. This was the ARTISTIC trial of HPV cervical screening. It was one of the largest cervical screening studies ever performed, and showed that HPV testing is more sensitive than cervical cytology and enables women to be safely screened at longer intervals (Lancet Oncology 2009;10:672-82). As a result of this and other evidence, the Government announced that national conversion of the cervical screening programme from cytology to HPV testing will be implemented at the end of 2019.
Underpinning Manchester’s achievements in this field has been a collaborative spirit, harnessing science and clinical excellence within the University and the Trust.