The population impact of human papillomavirus vaccination on cancer and pre-cancer outcomes - An umbrella review of meta-analyses

Sep 22, 2026

Despite widespread HPV vaccination, a comprehensive synthesis of population-level effects on infection and cancer outcomes across populations remains limited. This umbrella review evaluates how prophylactic HPV vaccination influences infection, precancerous lesions, and invasive cancers by searching five databases for meta-analyses up to Jan 2026. Selection and data extraction were performed by two reviewers using AMSTAR-2 and GRADE. Results summarize very high vaccine efficacy and graded certainty, with promising but emerging evidence for invasive cancer prevention and needs for immunocompromised research.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Introduction

Background on HPV and cervical cancer burden

Vaccination and screening strategies

Review Methods and Evidence Summary

Search and study selection

Key efficacy and risk-reduction findings

Certainty of evidence and research gaps

REVIEW The population impact of human papillomavirus vaccination on cancer and pre-cancer outcomes: An umbrella review of meta-analyses Fakher Rahim a,b and Ümit Atasever c aFaculty of Medicine, Department of Medical Biology, Kocaeli University, Kocaeli, Türkiye; bDepartment of Internal Medicine, Osh State University, Osh City, Kyrgyzstan; cDepartment of Nursing, Faculty of Health Sciences, Kocaeli University, Kocaeli, Türkiye ABSTRACT Despite widespread HPV vaccination, a comprehensive synthesis across populations and cancer outcomes is lacking. This umbrella review evaluates HPV vaccination’s population impact on infection, precancerous lesions, and invasive cancers. We searched five databases for meta-analyses reporting prophylactic HPV vaccine outcomes up to Jan 2026. Two reviewers performed selection, data extraction, AMSTAR-2, and GRADE. From 34 meta-analyses, RCTs in HPV-naïve women showed 99% efficacy (95% CI: 98– 99%) against HPV16/18 infection, 96% against CIN2+, and 89% against anogenital warts. Observational studies found relative risks of 0 .12–0.36 (HPV16/18) and 0.48–0.68 (CIN2+) . In men, effectiveness against warts was 74–90% . Ecological studies reported reductionsin cervical cancer of 57–88% . GRADE certainty was high for infection/warts, moderate for precancer, and low for invasive cancer. HPV vaccination is highly effective. Invasive cancer prevention evidence is promising but emerging. Further research in immunocompromised populations is needed. ARTICLE HISTORY Received 15 January 2026 Revised 24 June 2026 Accepted 2 July 2026 KEYWORDS Human papillomavirus; HPV vaccines; cancer prevention; umbrella review; uterine cervical neoplasms Introduction Chronic infections with oncogenic human papillomavirus (HPV) types are major contributors to cervical and other malignancies, including anal, vulvar, vaginal, penile, and oropharyngeal cancers worldwide. 1 The development of prophylactic HPV vaccines employing L1 capsid protein virus-like particles (VLPs) marked a substantial progression in cancer prevention. These immunizations elicit a robust, type-specific neutralizing antibody response that prevents initial infection.2 The World Health Organization (WHO) states that cervical cancer ranks as the fourth most prevalent malignancy among women.3 By 2030, it is anticipated to cause about 443,000 fatalities globally each year, with 98% of these deaths occurring in developing nations, predominantly in sub-Saharan Africa.4 Cervical cancer risk factors are categorized into modifiable and nonmodifiable kinds.5 Modifiable factors include sexual history, tobacco consumption, HPV infection, immunosuppression, chlamydia, prolonged use of oral contraceptives, multiple pregnancies, early initiation of full-term pregnancy, socioeconomic status, and poor nutrition. Non-modifiable factors encompass exposure to diethylstilbestrol and familial history. Nearly 99% of cervical cancers are linked to high-risk HPV strains.6 Fortunately, two tiers of intervention have contributed to a reduction in cervical cancer mortality globally.7 Vaccination is the most effective method for disease prevention, followed by screening treatments such as Pap smears.8 The American Cancer Society recommends that those aged 9 to 26 who have not completed their HPV vaccination series do so promptly. It is essential to acknowledge that no vaccine provides protection against all HPV strains, so regular monitoring is required.9 Initially, vaccines solely provided protection against high-risk HPV16 and HPV18, which account for around 70% of cervical cancers. 10 Quadrivalent and nonavalent vaccines additionally confer protection against low-risk HPV6 and HPV11, which are associated with anogenital warts.11 CONTACT Fakher Rahim [Bioinfo2003@gmail.com](Bioinfo2003@gmail.com) Department of Internal Medicine, Osh State University, 331 Lenin Avenue, Osh City 723500, Kyrgyzstan. Supplemental data for this article can be accessed online a

FAQs

What does the umbrella review assess about HPV vaccination outcomes?

It evaluates population impact on HPV infection, precancerous lesions, and invasive cancers by synthesizing evidence from meta-analyses across populations.

How were the included meta-analyses selected and assessed?

Five databases were searched for meta-analyses reporting prophylactic HPV vaccine outcomes up to Jan 2026, with two reviewers handling selection and data extraction. Evidence quality was assessed using AMSTAR-2 and certainty graded with GRADE.

What are the main findings on vaccine effectiveness and cancer prevention evidence?

RCTs in HPV-naïve women show high efficacy against HPV16/18 infection and related precancer endpoints, and observational and ecological studies indicate reduced risk and cervical cancer reductions. Evidence for invasive cancer prevention is described as promising but emerging, with stronger certainty for infection and warts than for invasive cancer.

Sep 22, 2026

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