Human papillomavirus vaccination and subsequent cervical cancer screening in a large integrated healthcare system

Abstract

Background Human papillomavirus vaccination may result in lowered intention to be screened for cervical cancer, potentially leading to gaps in screening coverage and avoidable cervical cancer diagnoses. Objective To examine the association between human papillomavirus vaccination and subsequent cervical cancer screening initiation and adherence to recommended screening intervals to detect gaps in screening coverage and inform future prevention efforts. Study Design A retrospective cohort study was conducted in two distinct cohorts of female members of Kaiser Permanente Southern California, a large integrated healthcare delivery system. Pap screening initiation was evaluated in women who reached age 21 years between 2010 and 2013. Adherence to recommended screening intervals was evaluated in women between ages 25–30 years in 2010. All women were followed to the end of 2013 for the evaluation of their screening behaviors. History of human papillomavirus vaccination and Pap screening were obtained from electronic medical records. Adherence to recommended screening intervals was measured as ≥85% vs. <85% of the observed “screening up-to-date” person-time. Multivariable Cox and logistic regression models were used to examine associations between vaccination history and screening initiation and interval adherence. Demographic characteristics, gynecological health history, healthcare utilization, and characteristics of women’s primary care providers were included as potential confounders in analyses. Results There were 27,352 and 41,328 women included in the screening initiation and screening interval adherence analyses, respectively. In comparison to unvaccinated women, adjusted hazard ratios [95% confidence intervals (CIs)] for screening initiation among human papillomavirus vaccinated women were 1.19 (1.11–1.28), 1.44 (1.34–1.53) and 1.57 (1.50–1.65), for 1, 2 and 3+ doses, respectively. Adjusted odds ratios (and CIs) for screening interval adherence were 0.93 (0.83–1.04), 1.73 (1.52–1.97) and 2.29 (2.05–2.56), for 1, 2 and 3+ dose, respectively. Conclusion Human papillomavirus vaccinated women in this community-based, integrated healthcare setting were more likely to be screened for cervical cancer than were unvaccinated women. Our findings underscore the need for targeted interventions among unvaccinated women, who may be disproportionally affected by cervical cancer despite the presence of population-based screening programs.

National assessment of HPV and Pap tests: Changes in cervical cancer screening, National Health Interview Survey

“…Our preliminary analysis showed that on the contrary, vaccinated women of all ages, as well as those aged 21–29, were more likely to be screened than unvaccinated women. These findings are consistent with previous research (Chao et al, 2017). Associations between vaccine receipt and cervical cancer screening were not significant in the multivariate adjusted analysis.…”

Cervical cancer screening in the era of HPV vaccination: A review of shifting paradigms in cytopathology

“…Large population‐based studies in Sweden and the US analyzing the association between HPV vaccination and subsequent cervical cancer screening initiation and compliance with recommended screening intervals have shown that HPV‐vaccinated women were more likely than their unvaccinated counterparts to initiate cervical cancer screening and to adhere to recommended screening intervals. These results highlight a potential emerging disparity in protection among vaccinated and unvaccinated women, with the latter being also less prone to seek and adhere to cancer screening …”

“…These results highlight a potential emerging disparity in protection among vaccinated and unvaccinated women, with the latter being also less prone to seek and adhere to cancer screening. 105,106 In terms of the perceived change in sexual activity or sexual intention following vaccination, the study by NHANES found no significant changes in the percentage of women reporting sexual activity or number of sexual partners between the pre-and post-vaccination era;…”

“…The impact of HPV vaccination on cervical cancer screening has been analyzed in various studies most of them demonstrating a positive correlation between HPV vaccination and cervical screening, in spite of a perception that vaccination would lead to patient's reassurance and decreased cervical cancer screening. [101][102][103][104][105][106] A population-based survey in the U.S. showed that 96% of participants were aware of the fact that Pap tests were still needed after vaccination. 107 In that same study, although only 12.3% of women had received the vaccine, 98.1% reported the intention to undergo a Pap test in the next 3 years, as compared to 92.7% in the unvaccinated group.…”

“…For these reasons, HPV vaccination does not eliminate the need for cervical cancer screening. The impact of HPV vaccination on cervical cancer screening has been analyzed in various studies most of them demonstrating a positive correlation between HPV vaccination and cervical screening, in spite of a perception that vaccination would lead to patient's reassurance and decreased cervical cancer screening . A population‐based survey in the U.S. showed that 96% of participants were aware of the fact that Pap tests were still needed after vaccination .…”