HPV vaccination and the risk of invasive cervical cancer

Summary

A study «Lei J, Ploner A, Elfström KM et al. HPV Vaccination and the Risk of Invasive Cervical Cancer. N Engl J Med 2020;383(14):1340-1348. »1 using nationwide Swedish registers assessed the relationship between quadrivalent HPV vaccination and risk of invasive cervical cancer in a population of 1 672 983 girls and women who were 10 to 30 years of age from 2006 through 2017. After adjustment for age at follow-up, the incidence rate ratio for the comparison of the vaccinated population with the unvaccinated population was 0.51 (95% CI 0.32 to 0.82). After adjustment for all covariates, the incidence rate ratio was 0.12 (95% CI 0.00 to 0.34) among women who had been vaccinated before the age of 17 years and 0.47 (95% CI 0.27 to 0.75) among women who had been vaccinated at the age of 17 to 30 years.

A population-based study in the Netherlands «Middeldorp M, Brouwer JGM, Duijster JW, et al. The effect of bivalent HPV vaccination against invasive cervical cancer and cervical intraepithelial neoplasia grade 3 (CIN3+) in the Netherlands: a popu»3 linked the vaccination status of women born in 1993 who were eligible for HPV vaccination at age 16 years with histopathological results recorded until April, 2024. A total of 103 059 women were included, of whom 47 130 were fully vaccinated, 5098 partially vaccinated, and 50 831 unvaccinated. Five cancers (0.011%) were observed in fully vaccinated, 2 (0.039%) in partially vaccinated, and 42 (0.083%) in unvaccinated women. The cumulative risk ratios (CCRs) for fully vaccinated women compared with unvaccinated women was 0.085 (95% Cl 0.025 to 0.24) for cancer and 0.19 (0.16 to 0.23) for CIN3+. The CRR for partially vaccinated women was 0.52 (0.12 to 1.71) for cancer and 0.42 (0.30 to 0.57) for CIN3+.

A Cochrane review «Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors»1 «Arbyn M, Xu L, Simoens C et al. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database Syst Rev 2018;(5):CD009069. »2 included 26 trials with a total of 73 428 participants. In adolescent girls and women (aged 15 to 26) negative for hrHPV DNA at baseline, HPV vaccines reduce CIN2+, CIN3+, adenocarcinoma-in-situ (AIS) associated with HPV16/18 compared with placebo in adolescent girls and women (table «HPV vaccine effects in adolescent girls and women negative for hrHPV DNA at baseline»1). Studies were not of sufficient duration to evaluate cervical cancer outcomes.