The Participation of HPV-Vaccinated Women in a National Cervical Screening Program: Population-Based Cohort Study

Herweijer, Eva; Feldman, Adina L.; Ploner, Alexander; Arnheim-Dahlström, Lisen; Uhnoo, Ingrid; Netterlid, Eva; Dillner, Joakim; Sparén, Pär; Sundström, Karin

doi:10.1371/journal.pone.0134185

Cited by 42 publications

(51 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of course, lack of vaccination in this setting could be associated with social deprivation because the catch-up campaign did carry a greater risk of not accessing disadvantaged children than was the case with the schools-based programme for 12-to 13-year-olds. A similar finding 68 of greater uptake of cervical screening among vaccinated women was recently reported from Sweden among women aged 25-35 years. A recently published Scottish study 69 found that the rate of uptake among unvaccinated women was only 65% of that DISCUSSION NIHR Journals Library www.journalslibrary.nihr.ac.uk among vaccinated women.…”

Section: Effect Of Prior Human Papillomavirus Vaccinationsupporting

confidence: 86%

A cluster randomised trial of strategies to increase cervical screening uptake at first invitation (STRATEGIC)

Kitchener

Gittins

Rivero‐Arias

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

BackgroundFalling participation by young women in cervical screening has been observed at a time that has seen an increase in the incidence of cervical cancer in the UK in women aged < 35 years. Various barriers to screening have been documented, including fear, embarrassment and inconvenience.ObjectivesTo measure the feasibility, clinical effectiveness and cost-effectiveness of a range of interventions to increase the uptake of cervical screening among young women.DesignA cluster randomised trial based on general practices performed in two phases.SettingPrimary care in Greater Manchester and the Grampian region in Scotland.ParticipantsPhase 1: 20,879 women receiving their first invitation for cervical screening. Phase 2: 10,126 women who had not attended by 6 months.InterventionsPhase 1: pre-invitation leaflet or not, and access to online booking (Manchester only). Phase 2: (1) vaginal self-sampling kits (SSKs) sent unrequested (n = 1141); or (2) offered on request (n = 1290); (3) provided with a timed appointment (n = 1629); (4) offered access to a nurse navigator (NN) (n = 1007); or (5) offered a choice between a NN or a SSK (n = 1277); and 3782 women in control practices.Main outcome measuresUplift in screening compared with control practices, cost-effectiveness of interventions, and the women’s preferences explored in a discrete choice experiment.ResultsThe pre-invitation leaflet and offer of online booking were ineffective when compared with control practices at 3 months, 18.8% versus 19.2% [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.88 to 1.06;p = 0.485] and 17.8% versus 17.2% (OR 1.02, 95% CI 0.87 to 1.20;p = 0.802), respectively. The uptake of screening at 3 months was higher among previously human papillomavirus (HPV)-vaccinated women than unvaccinated women, 23.7% versus 11% (OR 2.07, 95% CI 1.69 to 2.53;p < 0.001). Among non-attenders, the SSK sent intervention showed a statistically significant increase in uptake at 12 months post invitation, 21.3% versus 16.2% (OR 1.51, 95% CI 1.20 to 1.91;p = 0.001), as did timed appointments, 19.8% versus 16.2% (OR 1.41, 95% CI 1.14 to 1.74;p = 0.001). The offer of a NN, a SSK on request, and a choice between timed appointments and NN were ineffective. Overall, there was a gradual rather than prompt response, as demonstrated by uptake among control practices. A discrete choice experiment indicated that women invited who had not yet attended valued the attributes inherent in self-sampling. The health economic analysis showed that both timed appointments and unsolicited SSK sent were likely to be cost-effective at a cost per quality-adjusted life-year (QALY) gained of £7593 and £8434, respectively, if extended across the national 25-year-old cohort throughout the duration of screening. The certainty of these being cost-effective at a ceiling ratio of £20,000 per QALY gained was > 90%.ConclusionWomen receiving their initial screening invitation frequently delay taking up the offer and the net impact of interventions was small. Timed appointments and SSKs sent to non-attenders at 6 months are likely to be a cost-effective means of increasing uptake and should be considered further. HPV vaccination in the catch-up programme was associated with an increased uptake of cervical screening. Future work should focus on optimising self-sampling in terms of age range, timing of offer for non-attenders and use of urine testing instead of vaginal samples.Trial registrationCurrent Controlled Trials ISRCTN52303479.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 68. See the NIHR Journals Library website for further project information.

show abstract

Section: Effect Of Prior Human Papillomavirus Vaccinationsupporting

confidence: 86%

A cluster randomised trial of strategies to increase cervical screening uptake at first invitation (STRATEGIC)

Kitchener

Gittins

Rivero‐Arias

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…We therefore made adjustments for parental education as a marker for socioeconomic status. We have also found in a previous study that women vaccinated in the opportunistic HPV‐vaccination program were equally, if not more likely, to attend the cervical screening program in Sweden at age 23 and onwards . Thus, higher cervical screening attendance among vaccinated women could result in a detection bias of relatively more cervical lesions in vaccinated compared to unvaccinated women and could result in underestimation of the impact of vaccination on high‐grade cervical lesions.…”

Section: Discussionmentioning

confidence: 99%

Quadrivalent HPV vaccine effectiveness against high‐grade cervical lesions by age at vaccination: A population‐based study

Herweijer

Sundström

Ploner

et al. 2016

Intl Journal of Cancer

Self Cite

117

View full text Add to dashboard Cite

Human papillomavirus (HPV) types 16/18, included in HPV vaccines, contribute to the majority of cervical cancer, and a substantial proportion of cervical intraepithelial neoplasia (CIN) grades 2/3 or worse (CIN2+/CIN3+) including adenocarcinoma in situ or worse. The aim of this study was to quantify the effect of quadrivalent HPV (qHPV) vaccination on incidence of CIN2+ and CIN3+. A nationwide cohort of girls and young women resident in Sweden 2006–2013 and aged 13–29 (n = 1,333,691) was followed for vaccination and histologically confirmed high‐grade cervical lesions. Data were collected using the Swedish nationwide healthcare registers. Poisson regression was used to calculate incidence rate ratios (IRRs) and vaccine effectiveness [(1‐IRR)x100%] comparing fully vaccinated with unvaccinated individuals. IRRs were adjusted for attained age and parental education, and stratified on vaccination initiation age. Effectiveness against CIN2+ was 75% (IRR = 0.25, 95%CI = 0.18–0.35) for those initiating vaccination before age 17, and 46% (IRR = 0.54, 95%CI = 0.46–0.64) and 22% (IRR = 0.78, 95%CI = 0.65–0.93) for those initiating vaccination at ages 17–19, and at ages 20–29, respectively. Vaccine effectiveness against CIN3+ was similar to vaccine effectiveness against CIN2+. Results were robust for both women participating to the organized screening program and for women at prescreening ages. We show high effectiveness of qHPV vaccination on CIN2+ and CIN3+ lesions, with greater effectiveness observed in girls younger at vaccination initiation. Continued monitoring of impact of HPV vaccination in the population is needed in order to evaluate both long‐term vaccine effectiveness and to evaluate whether the vaccination program achieves anticipated effects in prevention of invasive cervical cancer.

show abstract

“…In Sweden, opportunistic HPV-vaccination was associated with an equal or higher attendance after invitation to cervical screening [47]. …”

Section: Screening Conditional On Vaccination Statusmentioning

confidence: 99%

Cervical cancer screening of HPV vaccinated populations: Cytology, molecular testing, both or none

El‐Zein

Richardson

Franco

2016

Journal of Clinical Virology

View full text Add to dashboard Cite

Cervical cancer control includes primary prevention through vaccination to prevent human papillomavirus (HPV) infection and secondary prevention through screening to detect and treat cervical precancerous lesions. This review summarizes the evidence for the population impact of vaccines against oncogenic HPV types in reducing the prevalence of cervical precancerous lesions. We examine the gradual shift in screening technology from cervical cytology alone to cytology and HPV cotesting, and finally to the recognition that HPV testing can serve alone as the new screening paradigm, particularly in the initial post-vaccination era. We should expect an impact on screening performance and practices, as cohorts of HPV-vaccinated girls and adolescents reach cervical cancer screening age. In preparation for changes in the screening paradigm for the vaccination era, we propose that policymaking on cervical cancer screening should mirror current practices with other cancers as benchmarks. Cervical precancerous lesions will become a very rare condition following the widespread implementation of HPV vaccines with broader coverage in the number of preventable oncogenic types. Irrespective of screening technology, the false positive results will far outnumber the true positive ones, a tipping point that will herald a new period when the harms from cervical cancer screening will outweigh its benefits. We present a conceptual framework to guide decision making when we reach this point within 25–30 years.

show abstract

The Participation of HPV-Vaccinated Women in a National Cervical Screening Program: Population-Based Cohort Study

Cited by 42 publications

References 23 publications

A cluster randomised trial of strategies to increase cervical screening uptake at first invitation (STRATEGIC)

A cluster randomised trial of strategies to increase cervical screening uptake at first invitation (STRATEGIC)

Quadrivalent HPV vaccine effectiveness against high‐grade cervical lesions by age at vaccination: A population‐based study

Cervical cancer screening of HPV vaccinated populations: Cytology, molecular testing, both or none

Contact Info

Product

Resources

About