Adherence to cervical cancer screening varies by human papillomavirus vaccination status in a high-risk population

Abstract

Cervical cancer screening has reduced the incidence of cervical cancer over the past 75 years. The primary aim of this study was to determine if women receiving Gardasil™ (HPV4 vaccine) participated in future cervical cancer screening at the same rate as that observed for unvaccinated women matched on birth year and health care campus. This is a retrospective cohort study of subjects selected from 27,786 females born from 1980 to 1992 who received health care in the Truman Medical Center safety net health system in Kansas City Missouri, USA. 1154 women 14–26 years old who received at least one dose of HPV4 vaccine between 2006 and 2009 were chosen at random from the vaccine records. 1154 randomly chosen unvaccinated women were age and health campus matched to the vaccinated women and all were followed until July 1, 2013. Women who were screened after 21 years and received three vaccine doses before 21 years, had the lowest screening rate of 24%. Their only predictive factor for screening, compared to the unvaccinated, was being closer to 21 years than 14 years at vaccination (aOR = 1.71 95% CI: 1.45, 2.00). Women vaccinated with three doses and screened at or after 21 years had the highest screening rate of 84% predicting a six-fold increase in screening participation over no vaccine received (aOR = 5.94 95% CI: 3.77, 9.35). Our results suggest that women who receive HPV4 vaccination closer to 21 years, not 14, are more likely to participate in cervical cancer screening in an underserved US population.

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

“…Consequently, their findings may not generalize to women in the US. Paynter et al reported a higher level of screening in vaccinated women than in unvaccinated women in a safety net health care system in Kansas City 10 . Using US administrative claim data, Hirth et al reported a positive dose response by number of HPV vaccine received with subsequent Pap screening 9 .…”

“…Because the vaccination decision for girls 11–12 years of age is primary made by parents, it is unclear whether the positive association between vaccination and screening behavior we observed here is generalizable to women who first received the vaccine at an earlier age. In fact, Paynter et al reported that women vaccinated closer to age 21 were more likely to get screening than those vaccinated at age 14 10 . Thus, future studies are needed to confirm the association between vaccination in the recommended age range and subsequent screening behavior.…”

“…While the findings of several surveys suggest that vaccination is generally not associated with a reduced willingness for screening 3,6–8 , actual screening behaviors after receipt of the HPV vaccine have not been comprehensively examined. Two studies in the United States (US) reported a positive association between vaccination and subsequent screening, but these studies were not designed to elucidate the nature of this relationship, which requires accounting for important differences in clinical and utilization histories between women with and without vaccination 9,10 . To address these gaps in the literature, we examined the relationship between HPV vaccination and subsequent screening initiation and adherence to recommended screening intervals among female members of Kaiser Permanente Southern California (KPSC).…”

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 …”

“…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 .…”