Can the prophylactic quadrivalent HPV vaccine be used as a therapeutic agent in women with CIN? A randomized trial

Abstract

Background: Human papillomavirus (HPV) is one of the most significant risk factors for cervical cancer. The HPV vaccine has a very significant impact on the incidence of cervical cancer. The present study aimed to investigate the impact of prophylactic quadrivalent HPV vaccine in the treatment of women with cervical intraepithelial neoplasia (CIN 1-3). Methods: This randomized controlled trial was conducted in the Shahid Sadoughi University of Medical Sciences (SSUMS), Yazd, Iran, from October 2011 to November 2015 in women with histologically confirmed residual/ recurrent CIN 1 or high-grade CIN (CIN 2-3). Eligible women were assigned randomly to an intervention and a control group. Women in the intervention group were given HPV vaccinations while those in the control group were not. Participants were followed up for 24 months. Primary and secondary outcomes, and adverse effects of the treatment in the two groups were compared using Student's t test, the chi-square test, or Fisher's exact test. P values < 0.05 or less were considered statistically significant. Results: Three-hundred and twelve women were randomized to the two groups; the data of 138 in the intervention group and 104 in the control group were analyzed. The mean age of the women was 32.59 ± 4.85 years. Differences in age, marital status, and grades of CIN weren't significant between the two groups. At the end of the two-year follow-up period, the number of women with CIN 2-3 in the intervention and control groups was reduced by 75% (from 93 to 23) versus 40% (from 69 to 41). The efficacy of the HPV vaccine in women with CIN 1-3 was 58.7% (p = 0.018). No serious adverse effects related to the vaccines were reported. Conclusions: The prophylactic quadrivalent HPV vaccine after treatment may have a therapeutic effect in women with residual/recurrent CIN 1 or high-grade CIN (CIN 2-3). Trial registration: Iranian Registry of Clinical Trials, IRCT20190603043801N1.

Has COVID-19 Affected Cancer Screening Programs? A Systematic Review

“…Health care services across the globe have been profoundly affected by COVID-19, and the consequences of the pandemic are yet unforeseeable (3,4). A large number of medical procedures, elective and non-urgent scheduled surgeries, and elective visits have been canceled or rescheduled (5,6). Telehealth is used for non-acute issues in some countries (7), while population-based cancer screening programs have been suspended in others (5).…”

“…Both, patients and personnel at hospital sites experience fear and anxiety (5). There has been a marked decline in cancer screening and diagnosis, the development of tumor markers, the use of imaging procedures, biopsies, colonoscopy, gastroscopy, sigmoidoscopy, stool tests, low-dose computed tomography (LDCT), mammography, Pap tests, human papillomavirus (HPV) testing, colposcopy, laparoscopy, and melanoma screening (6,8,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Adjuvant HPV Vaccination to Prevent Recurrent Cervical Dysplasia after Surgical Treatment: A Meta-Analysis

“…Enormous attempts are being made to obtain the first therapeutic HPV vaccine [ 15 , 16 , 17 ]. In the meantime, interesting data suggest that the administration of prophylactic HPV vaccine, either shortly before or after surgical treatment for CIN 2+, might reduce the risk of recurrence [ 18 , 19 , 20 ].…”

“…Vaccines 2021, 9, 410 2 of 16 Despite the increasing introduction of HPV vaccines and screening strategies, cervical cancer still remains the first most common gynecological cancer worldwide [1,5]. Currently, over one hundred countries around the world, accounting for 30-50% of the target population, have included HPV vaccination into their routine prevention programs [6][7][8].…”

Accuracy of the Triple Test Versus Colposcopy for the Diagnosis of Premalignant and Malignant Cervical Lesions

“…Cervical cancer is the fourth most common type of cancer in women worldwide (Consul et al, 2012). Due to the absence of effective and regular screening programs aimed at identifying and treating precancerous lesions, and the absence of human papillomavirus (HPV) vaccines (Karimi-Zarchi et al, 2020), cervical cancer is the most common gynecologic cancer in some developing countries (Consul et al, 2012, Bray et al, 2018. The disease is considered preventable because of its long period of premalignancy and organized screening was shown to pathologists (Rambau, 2011, Catarino et al, 2018.…”