Human papillomavirus (HPV) vaccination has transformed cervical cancer prevention
worldwide. Initially introduced to prevent HPV infection before sexual exposure, vaccination is
now also recognized as an important strategy for reducing the risk of recurrent high-grade
cervical lesions after treatment. In 2026, Brazil expanded this preventive approach by
recommending HPV vaccination through the Brazilian National Immunization Program (PNI) for
women diagnosed with high-grade cervical intraepithelial neoplasia (CIN2+), including CIN2,
CIN3, and adenocarcinoma in situ (AIS), who undergo excisional treatment such as loop
electrosurgical excision procedure (LEEP) or cervical conization.
This policy represents an important evolution in cervical cancer prevention. Rather than focusing exclusively on preventing HPV infection before viral exposure, Brazil now recognizes the
growing evidence that vaccination also provides benefits after treatment of precancerous
cervical lesions, reducing the likelihood of recurrent disease and supporting long-term
cervical health.
Why does cervical cancer remain a major public health challenge in Brazil?
Despite being largely preventable, cervical cancer continues to impose a substantial health
burden in Brazil. According to the Brazilian National Cancer Institute (INCA), an estimated
19,310 new cervical cancer cases are expected annually during the 2026–2028 period,
making it the third most common cancer among Brazilian women, excluding non-melanoma
skin cancer. Cervical cancer is also responsible for approximately 7,500 deaths each year,
remaining one of the leading causes of cancer-related mortality among women, particularly in
regions with lower socioeconomic development and reduced access to preventive
healthcare.
Persistent infection with oncogenic HPV types is the necessary cause of virtually all cervical
cancers. HPV16 and HPV18 alone account for approximately 70% of cervical cancer cases
worldwide, emphasizing the enormous preventive potential of HPV vaccination.
Although Brazil has made significant progress in expanding HPV vaccination among
adolescents and improving cervical cancer screening, vaccination coverage remains
heterogeneous across regions, and many women are still diagnosed with precursor lesions or
invasive disease. These disparities highlight the importance of combining primary prevention
through vaccination with effective screening and timely treatment.
How has HPV vaccination changed the future of cervical cancer prevention?
HPV vaccination is one of the greatest achievements in cancer prevention. Countries that
introduced nationwide vaccination programs with high coverage have already reported
dramatic reductions in HPV infections, genital warts, cervical intraepithelial neoplasia, and
cervical cancer incidence among younger generations.
Australia has become the international benchmark for HPV prevention. Thanks to high
vaccination coverage combined with organized cervical screening, modelling studies suggest that cervical cancer could become a rare disease within the next decades. Similar trends have been observed in the United Kingdom, Sweden, and several other countries with robust vaccination programs.
These experiences support the World Health Organization’s global strategy to eliminate
cervical cancer as a public health problem through the 90-70-90 targets: vaccinating 90% of
girls by age 15, screening 70% of women with a high-performance test, and ensuring that 90%
of women with cervical disease receive appropriate treatment. Achieving these goals could
prevent millions of cervical cancer cases worldwide over the coming decades.
Why vaccinate women after treatment for CIN2 or CIN3?
One of the most important advances in recent years has been the recognition that HPV
vaccination also benefits women who have already developed high-grade cervical lesions.
It is important to emphasize that the HPV vaccine does not treat existing cervical
intraepithelial neoplasia nor eliminate established HPV infection. Surgical excision remains the
standard treatment for CIN2, CIN3, and AIS.
However, women treated for high-grade cervical lesions remain at increased risk of persistent
HPV infection, reinfection, and recurrent disease. Studies have shown recurrence rates of up
to 17% after excisional treatment.
Growing evidence indicates that administering the HPV vaccine around the time of treatment
significantly reduces the risk of recurrent CIN2+ lesions. Proposed mechanisms include
prevention of infection with new HPV types, reduction of reinfection, and enhancement of
immune protection against vaccine-covered HPV types. Although vaccination is not
therapeutic, it appears to decrease the likelihood that new HPV infections will lead to
recurrent precancerous lesions.
Recent systematic reviews and meta-analyses have demonstrated substantial reductions in
recurrent CIN2+ among vaccinated women after excisional treatment, leading several
international societies to recommend adjuvant HPV vaccination for previously unvaccinated
individuals undergoing treatment for high-grade cervical disease.
These findings formed the scientific basis for Brazil’s decision to expand access to HPV
vaccination for women treated for CIN2+, recognizing vaccination as an additional preventive
strategy after treatment rather than solely before HPV exposure.
What does Brazil’s new policy mean for cervical cancer prevention?
The inclusion of women treated for CIN2+ in the National Immunization Program reflects an
evolving understanding of cervical cancer prevention.
Traditionally, prevention was divided into:
- Primary prevention: HPV vaccination before viral exposure.
- Secondary prevention: Cervical screening and treatment of precursor lesions.
The new recommendation bridges these two approaches by incorporating vaccination into
the continuum of care after treatment of high-grade lesions.
Potential benefits include:
- Reduced recurrence of CIN2+ after excisional treatment.
- Fewer repeat LEEP or conization procedures.
- Better preservation of future reproductive outcomes by decreasing the need for
repeated cervical excisions. - More efficient use of healthcare resources.
- Further reduction in the long-term burden of HPV-related disease.
This policy also aligns Brazil with an expanding international movement toward integrating
HPV vaccination into comprehensive cervical cancer prevention strategies.
Successful implementation, however, will require continued efforts to improve vaccination
coverage, ensure equitable access across all regions of the country, educate healthcare
professionals, and maintain high-quality cervical screening programs. Vaccination
complements—but does not replace—routine follow-up after treatment or participation in
organized cervical cancer screening.
Written by Dr. Marianne Potengy, MD
Surgical Oncologist | Brazil Hub, OncoDaily
FAQ
Who is eligible under the new recommendation?
Women diagnosed with high-grade cervical intraepithelial neoplasia (CIN2 or CIN3) or adenocarcinoma in situ (AIS) who undergo excisional treatment (LEEP or conization) are included among the priority groups for HPV vaccination within the Brazilian National Immunization Program.
Why vaccinate after treatment?
Vaccination reduces the risk of developing new HPV-related lesions after treatment, lowering recurrence rates and complementing surgical management.
Does vaccination replace cervical cancer screening?
No. Women should continue participating in recommended cervical cancer screening and follow-up after treatment, even if vaccinated.
Can HPV vaccination contribute to cervical cancer elimination?
Yes. When combined with high vaccination coverage, effective screening, and timely treatment of precursor lesions, HPV vaccination is considered one of the key pillars of the World Health Organization's strategy to eliminate cervical cancer as a public health problem.