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

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 reductions in 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.