Estimating the direct effect of human papillomavirus vaccination on the lifetime risk of screen-detected cervical precancer.
Adult
Aged
Cohort Studies
Early Detection of Cancer
Female
Humans
Middle Aged
Netherlands
/ epidemiology
Papillomaviridae
/ immunology
Papillomavirus Infections
/ epidemiology
Papillomavirus Vaccines
/ administration & dosage
Precancerous Conditions
/ epidemiology
Randomized Controlled Trials as Topic
Risk
Uterine Cervical Neoplasms
/ epidemiology
Vaccination
/ statistics & numerical data
Uterine Cervical Dysplasia
/ epidemiology
HPV-based screening
cervical intraepithelial neoplasia (CIN)
human papillomavirus (HPV)
lifetime risk
prophylactic vaccination
Journal
International journal of cancer
ISSN: 1097-0215
Titre abrégé: Int J Cancer
Pays: United States
ID NLM: 0042124
Informations de publication
Date de publication:
15 01 2021
15 01 2021
Historique:
received:
15
11
2019
revised:
17
06
2020
accepted:
29
06
2020
pubmed:
15
7
2020
medline:
9
6
2021
entrez:
15
7
2020
Statut:
ppublish
Résumé
Birth cohorts vaccinated against human papillomavirus (HPV) are now entering cervical cancer screening. Assessment of (pre)cancer (CIN3+) risk is needed to assess the residual screening need in vaccinated women. We estimated the lifetime (screen-detected) CIN3+ risk under five-yearly primary HPV screening between age 30 and 60, using HPV genotyping and histology data of 21,287 women participating in a screening trial with two HPV-based screening rounds, 5 years apart. The maximum follow-up after an HPV-positive test was 9 years. We re-estimated the CIN3+ risk after projecting direct vaccine efficacy for the bivalent and the nonavalent HPV vaccines, assuming life-long protection. The lifetime CIN3+ risk was 4.1% (95% confidence interval 3.5-4.9) and declined by 53.5% and 70.5% after bivalent vaccination without and with cross-protection, respectively, translating into a residual lifetime CIN3+ risk of 1.9% (1.4-2.4) and 1.2% (0.9-1.5). The CIN3+ risk declined by 88.5% after nonavalent vaccination, translating into a residual lifetime CIN3+ risk of 0.5% (0.2-0.7). The latter risk increased to 1.6% when vaccine protection only lasted until the first screening round at age 30. Among HPV-positive women with abnormal adjunct cytology, the nine-year CIN3+ risk was 16.9% (8.7-32.4) after nonavalent vaccination. In conclusion, HPV vaccination will lead to a strong decline in the lifetime CIN3+ risk and the remaining absolute CIN3+ risk will be very low. Primary HPV testing combined with adjunct cytology at five-year intervals still seems feasible even after nonavalent vaccination, although unlikely to be cost-effective. Our results support a de-intensification of screening programs in settings with high vaccination coverage.
Identifiants
pubmed: 32663316
doi: 10.1002/ijc.33207
pmc: PMC7754437
doi:
Substances chimiques
Papillomavirus Vaccines
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
320-328Informations de copyright
© 2020 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of Union for International Cancer Control.
Références
Am J Obstet Gynecol. 2007 Oct;197(4):356.e1-6
pubmed: 17904958
Lancet Oncol. 2008 May;9(5):425-34
pubmed: 18407790
Int J Cancer. 2021 Jan 15;148(2):320-328
pubmed: 32663316
Br J Cancer. 2012 Apr 24;106(9):1571-8
pubmed: 22441643
Int J Cancer. 2016 Jun 15;138(12):2922-31
pubmed: 26845632
Lancet Infect Dis. 2017 Dec;17(12):1293-1302
pubmed: 28965955
Br J Cancer. 2020 Jul;123(1):155-160
pubmed: 32362659
Cancer. 2015 Apr 15;121(8):1156-7
pubmed: 25855331
J Infect Dis. 2018 Jan 4;217(2):213-222
pubmed: 29140439
Hum Vaccin Immunother. 2014;10(8):2147-62
pubmed: 25424918
J Natl Cancer Inst. 2008 Mar 5;100(5):308-20
pubmed: 18314477
Vaccine. 2012 Feb 27;30(10):1813-22
pubmed: 22240341
Lancet Oncol. 2011 Jul;12(7):663-72
pubmed: 21684207
Epidemiology. 2011 Jul;22(4):505-15
pubmed: 21540743
Lancet. 2009 Jul 25;374(9686):301-14
pubmed: 19586656
Int J Cancer. 2017 May 15;140(10):2192-2200
pubmed: 28006858
J Obstet Gynaecol Res. 2018 Jun;44(6):989-997
pubmed: 29517117
Lancet Oncol. 2012 Jan;13(1):89-99
pubmed: 22075171
J Clin Pathol. 2004 Apr;57(4):388-93
pubmed: 15047743
Prev Med. 2017 May;98:21-30
pubmed: 27894910
Cell Oncol. 2007;29(1):19-24
pubmed: 17429138
J Infect Dis. 2011 Apr 1;203(7):910-20
pubmed: 21402543
N Engl J Med. 2015 Feb 19;372(8):711-23
pubmed: 25693011
F1000Res. 2017 Jun 12;6:866
pubmed: 28663791
Cancer Discov. 2011 Oct;1(5):408-19
pubmed: 22586631
J Infect Dis. 2017 Jul 15;216(2):210-219
pubmed: 28586466
J Infect Dis. 2019 Aug 30;220(7):1141-1146
pubmed: 31165164
Lancet Oncol. 2012 Jan;13(1):100-10
pubmed: 22075170
Lancet Public Health. 2017 Feb;2(2):e96-e107
pubmed: 29253402
Int J Cancer. 2018 Mar 1;142(5):949-958
pubmed: 29055031
Cancer Epidemiol Biomarkers Prev. 2015 Jan;24(1):286-90
pubmed: 25277793
J Low Genit Tract Dis. 2013 Apr;17(5 Suppl 1):S36-42
pubmed: 23519303
Br J Cancer. 2003 Jul 7;89(1):101-5
pubmed: 12838308
Public Health Genomics. 2009;12(5-6):352-61
pubmed: 19684447
Lancet Public Health. 2018 Jan;3(1):e34-e43
pubmed: 29307386
Lancet. 2014 Feb 8;383(9916):524-32
pubmed: 24192252
Lancet. 2019 Aug 10;394(10197):497-509
pubmed: 31255301
Int J Cancer. 2016 Jun 15;138(12):2867-74
pubmed: 26856527
J Clin Microbiol. 2002 Mar;40(3):779-87
pubmed: 11880393
Lancet Oncol. 2012 Jan;13(1):78-88
pubmed: 22177579
J Natl Cancer Inst. 2016 Oct 18;109(2):
pubmed: 27754955
Cancer Epidemiol Biomarkers Prev. 2015 Jan;24(1):111-8
pubmed: 25300476
JAMA. 2002 Apr 24;287(16):2114-9
pubmed: 11966386
J Low Genit Tract Dis. 2013 Apr;17(5 Suppl 1):S28-35
pubmed: 23519302
Int J Cancer. 2004 May 20;110(1):94-101
pubmed: 15054873
Epidemiology. 2019 Jul;30(4):590-596
pubmed: 30985528
N Engl J Med. 2007 May 10;356(19):1915-27
pubmed: 17494925