Impact of Human Papillomavirus (HPV)-6/11/16/18 Vaccine on All HPV-Associated Genital Diseases in Young Women

Muñóz, Núbia; Kjær, Susanne K.; Sigurðsson, Kristján; Iversen, Ole Erik; Hernández-Ávila, Mauricio; Wheeler, Cosette M.; Pérez, Gonzalo; Brown, Darron R.; Koutsky, Laura A.; Tay, Eng Hseon; García, Patricia J.; Ault, Kevin A.; Garland, Suzanne M.; Leodolter, Sepp; Olsson, Sven Eric; Tang, Grace; Ferris, Daron G.; Paavonen, Jorma; Steben, Marc; Bosch, F. Xavier; Dillner, Joakim; Huh, Warner K.; Joura, Elmar A.; Kurman, Robert J.; Majewski, Sławomir; Myers, Evan R.; Villa, Luisa L.; Taddeo, Frank J.; Roberts, Christine C.; Tadesse, Amha; Bryan, Janine T.; Lupinacci, Lisa; Giacoletti, Katherine E.D.; Sings, Heather L.; James, Margaret K.; Hesley, Teresa M.; Barr, Eliav; Haupt, Richard M.

doi:10.1093/jnci/djp534

Cited by 499 publications

(329 citation statements)

References 34 publications

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“…However, 2nd and 3rd doses could have been given in the calendar year they turned 14 or in the calendar year they turned 15 years old respectively, depending on the date of the first dose and scheduled clinics. 2 Rate of completed HPV vaccine series for birth cohort in province reported from the provincial vaccine registry. arm and placebo arm for their main outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Randomized trials have shown that both the quadrivalent and bivalent HPV vaccines are highly efficacious in preventing HPV infection, cervical dysplasia, anal dysplasia and in the case of the quadrivalent vaccine, genital warts. [1][2][3][4][5] As part of the introduction of HPV vaccine globally, jurisdictions that started public programs were encouraged to embark on comprehensive monitoring programs to determine HPV vaccine safety, uptake, acceptability and impact of the program on HPV prevalence, cervical dysplasia and ultimately, cervical cancer. 6 Data from Australia, the United States and the United Kingdom have shown that the vaccine is effective, with population level reductions in rates of genital warts, HPV and cervical cancer lesions.…”

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confidence: 99%

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Reduction in cervical intraepithelial neoplasia in young women inBritishColumbia after introduction of theHPVvaccine: An ecological analysis

Naus

Money

Dobson

et al. 2015

Intl Journal of Cancer

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We report on the rates of cervical intraepithelial neoplasia (CIN) in young women aged 15-22 years of age in British Columbia before and after the introduction of an HPV vaccine program. Rates of cervical intraepithelial neoplasia (CIN) 21 for each age stratum (15)(16)(17)(18)(19)(20)(21)(22) in the calendar years 2004-2012 for the province of British Columbia were obtained from the BC Cancer Agency's population-based cervical cancer program. Incidence rate ratios (IRR) of CIN21 were described and compared before and after HPV vaccine program introduction in cohorts born in vaccine eligible years, and in non-vaccine eligible years using piece-wise Poisson regression analysis, and adjusted for age. Between 2004 and 2012, rates of CIN2 and CIN21 in young women aged 15-22 years in the province of British Columbia have decreased overall. After the introduction of the HPV vaccine program, the age adjusted IRR for CIN21 for young women aged 15-17 years decreased significantly from 0.91 (95% CI: 0.86-0.98 p < 0.01) to 0.36 (95% CI: 0.18-0.73 p < 0.01). During the same time period, no similar reduction was found in young women 18-22 years. After introduction of HPV vaccine program, IRR for CIN21 in young women 15-17 was significantly reduced for CIN21 (0.14; 95% CI: 0.04-0.47; p < 0.01) and CIN2 (0.1; 95% CI: 0.02-0.54; p < 0.01). This ecological analysis shows a significant reduction in CIN21 lesions in young women aged 15-17 years in British Columbia after the introduction of the HPV vaccine in young women despite vaccine uptake levels below 70%.The HPV vaccine is one of the most important innovations in cancer prevention. Randomized trials have shown that both the quadrivalent and bivalent HPV vaccines are highly efficacious in preventing HPV infection, cervical dysplasia, anal dysplasia and in the case of the quadrivalent vaccine, genital warts.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Reduction in cervical intraepithelial neoplasia in young women inBritishColumbia after introduction of theHPVvaccine: An ecological analysis

Naus

Money

Dobson

et al. 2015

Intl Journal of Cancer

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“…31 Data from two recently conducted randomised trials of HPV vaccines in young women demonstrated a 95% reduction in a combined endpoint of high grade vaginal or vulval intraepithelial neoplasia realted to HPV-16 and -18 in women who were initially unexposed to HPV. 35 …”

Section: Vaginal Cancermentioning

confidence: 99%

Cancers attributable to human papillomavirus infection

et al. 2010

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Abstract. Although the human papillomavirus (HPV) vaccine was introduced primarily as a cervical cancer prevention vaccine, HPV has a causal role in several types of cancer. This article reviews the epidemiological evidence for the role of HPV in human cancer, and describes Australian trends in these cancers. HPV is a necessary cause of cervical cancer. The currently vaccine-preventable subtypes of HPV 16 and 18 are responsible for~70% of cervical cancer. The introduction of an organised Pap smear program in Australia led to a steep decline in incidence over the past decades. HPV can be detected in~40% and 70% of vulval and vaginal cancers respectively. Rates of these cancers have been stable over the past 20 years. The prevalence of HPV in penile cancer is~50% and incidence has not recently changed. For anal cancer,~85% of cases are HPV positive, and incidence has increased significantly in both men and women over the past 20 years. In the oral cavity,~35% of oropharyngeal cancers and~25% of other oral cavity cancers are HPV positive. The incidence of HPV-related oral cavity and oropharyngeal cancers is increasing, whereas incidence at HPV-unrelated sites is decreasing. Overall, 1154 HPV-related cancer cases were potentially preventable by vaccination. If HPV-related cancers at non-cervical sites are prevented by vaccination, then a similar number of cancer cases will be prevented as in the cervix. However, almost one-quarter of the potentially preventable cancer cases are in men, who are not included in the current national immunisation program.

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“…34,35 Therefore, timely vaccination can prevent a fair part of the HPV disease burden. After the onset of vaccination referrals to colposcopy and CIN cases will first be prevented.…”

Section: Discussionmentioning

confidence: 99%

Divergent coverage, frequency and costs of organised and opportunistic Pap testing in Finland

Salo

Nieminen

Kilpi

et al. 2013

Intl Journal of Cancer

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We evaluated the overall coverage, frequency and costs of Pap testing by screening modality and health care provider in Finland. Information about Pap testing in the Finnish female population of 2.7 million was obtained from nationwide populationbased registry data. Among women aged 25-69 years, 87% had had a Pap test taken within or outside the organised programme at least once during the last 5 years and half of those screened in the organised programme had also had at least one Pap test taken outside the programme. Of the annual average of 530,000 Pap tests taken, 84% were taken for screening purposes and 16% as follow-up. Forty percent of the 446,000 annual screening tests were taken in the organised programme, 55% as opportunistic tests in public primary or student health care or by private providers and 5% in public secondary health care. One-fifth of all opportunistic screening Pap tests were taken from women aged <25. The voluminous opportunistic Pap testing in public primary health care was concentrated in young women aged 25-29 whereas the bulk of opportunistic testing in private health occurred in age groups eligible for organised screening. The total cost of all screening Pap tests was e22.4 million, of which 71% incurred in opportunistic screening. Of the 84,000 annual follow-up Pap tests and their e8.3 million total costs,~60% incurred in organised screening or in secondary health care.The organised screening programme for cervical cancer in Finland was started in the 1960s. 1 Within the programme women between 30 and 60 years of age are invited for screening every 5 years. 2 In addition, some municipalities invite also women aged 25 and/or 65 years. 3 The overall attendance rate to organised screening has been 70% with some variation by age and region. All Pap tests taken in the organised programme, including their results, are registered in the Mass Screening Registry. 4 Pap testing outside the organised programme is frequent but is not registered centrally. Until now, only survey data have been available to estimate the volume of such opportunistic testing and its impact on the incidence of cervical cancer. [5][6][7][8] According to the national guidelines in Finland, screening for cervical cancer should only take place every 5 years within the organised, population-based programme. 9 The effectiveness of this policy has been shown in several cohort and case-control studies. 10 The national guidelines recommend that asymptomatic women below age 25 should not be screened because of a negligible cancer risk. Moreover, organised screening in this age group has not shown to be effective. 11 The majority of new lesions in young women are known to regress spontaneously and because of the long average duration of the precancerous stages the few emerging precancers can be treated timely. 12-14 Previous reports suggest that the effectiveness and cost-effectiveness of organised screening is appropriate. 15,16 However, the role of opportunistic Pap testing in overall screening has remained unknown due to l...

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Impact of Human Papillomavirus (HPV)-6/11/16/18 Vaccine on All HPV-Associated Genital Diseases in Young Women

Cited by 499 publications

References 34 publications

Reduction in cervical intraepithelial neoplasia in young women inBritishColumbia after introduction of theHPVvaccine: An ecological analysis

Reduction in cervical intraepithelial neoplasia in young women inBritishColumbia after introduction of theHPVvaccine: An ecological analysis

Cancers attributable to human papillomavirus infection

Divergent coverage, frequency and costs of organised and opportunistic Pap testing in Finland

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