Beyond High-Risk Lesions: HPV Vaccination and Impact on Invasive Cervical Cancer Risk
BACKGROUND AND PURPOSE:
- HPV vaccine has been shown to be effective at preventing high-grade cervical lesions
- However, direct effect of quadrivalent HPV vaccine on the risk of invasive cervical cancer remains limited
- Lei et al. (NEJM, 2020) used a large cohort to examine the association between HPV vaccination and the risk of invasive cervical cancer
METHODS:
- Cohort study
- Participants
- Girls and women
- 10 to 30 years
- Living in Sweden (from 2006 to 2017)
- Study design
- Received at least one dose of vaccine
- Analysis controlled for
- Age at follow-up | Calendar year | County of residence | Parental characteristics (education, household income, mother’s country of birth, and maternal disease history)
- Primary outcome
- Invasive cervical cancer
RESULTS:
- 1,672,983 girls and women included
- Cervical cancer diagnoses
- Women who received the HPV vaccine: 19 diagnoses
- Women who had not received the HPV vaccine: 538 diagnoses
- Cumulative incidence of cervical cancer
- Received vaccination: 47 cases per 100,000 persons
- Did not receive vaccination: 94 cases per 100,000 persons
- Women who were vaccinated were 0.51 times less likely to experience cervical cancer compared to controls (adjusted for age at follow-up)
- Incidence rate ratio (IRR) 0.51 (95% CI, 0.32 to 0.82)
- After additional adjustment for other covariates, IRR was 0.37 (95% CI, 0.21 to 0.57)
- IRR following adjustment for all covariates
- Vaccinated <17 years
- IRR 0.12 (95% CI, 0.00 to 0.34)
- Vaccinated at 17 to 30 years
- IRR 0.47 (95% CI, 0.27 to 0.75)
- Vaccinated <17 years
CONCLUSION:
- In Sweden, quadrivalent HPV vaccination among women ages 10 to 30 was associated with reduced risk of invasive cervical cancer
- If vaccination initiated <17 years of age, the risk for cervical cancer was 88% lower vs the cohort that had never been vaccinated | Based on the confidence interval, the plausible risk was 66 to 100% lower with vaccination
- The authors conclude
HPV vaccination was associated with a substantially reduced risk of invasive cervical cancer
Learn More – Primary Sources:
HPV Vaccination and the Risk of Invasive Cervical Cancer
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