Outcomes of Conservative Management of High Grade Squamous Intraepithelial Lesions in Young Women

Lee, Marette; Finlayson, Sarah; Gukova, Ksenia; Hanley, Gillian E.; Miller, Dianne; Sadownik, Leslie

doi:10.1097/lgt.0000000000000399

Cited by 34 publications

(32 citation statements)

References 39 publications

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“… 22 CIN grade 3 is the precursor of invasive cervical carcinoma, with the least diagnostic variability and lowest rate of spontaneous regression, and it is recognised as the best indicator of the risk of invasive cancer. 23 24 25 It is therefore reasonable to expect that the reduction in CIN grade 3 will lead to a reduction in cervical cancer in future years. The anticipated impact of immunisation on cancer will take more time to become apparent.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study

Palmer

Wallace

Pollock

et al. 2019

BMJ

166

168

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Objective To quantify the effect on cervical disease at age 20 years of immunisation with bivalent human papillomavirus (HPV) vaccine at age 12-13 years. Design Retrospective population study, 1988-96. Setting National vaccination and cervical screening programmes in Scotland. Participants 138 692 women born between 1 January 1988 and 5 June 1996 and who had a smear test result recorded at age 20. Main outcome measures Effect of vaccination on cytology results and associated histological diagnoses from first year of screening (while aged 20), calculated using logistic regression. Results 138 692 records were retrieved. Compared with unvaccinated women born in 1988, vaccinated women born in 1995 and 1996 showed an 89% reduction (95% confidence interval 81% to 94%) in prevalent cervical intraepithelial neoplasia (CIN) grade 3 or worse (from 0.59% (0.48% to 0.71%) to 0.06% (0.04% to 0.11%)), an 88% reduction (83% to 92%) in CIN grade 2 or worse (from 1.44% (1.28% to 1.63%) to 0.17% (0.12% to 0.24%)), and a 79% reduction (69% to 86%) in CIN grade 1 (from 0.69% (0.58% to 0.63%) to 0.15% (0.10% to 0.21%)). Younger age at immunisation was associated with increasing vaccine effectiveness: 86% (75% to 92%) for CIN grade 3 or worse for women vaccinated at age 12-13 compared with 51% (28% to 66%) for women vaccinated at age 17. Evidence of herd protection against high grade cervical disease was found in unvaccinated girls in the 1995 and 1996 cohorts. Conclusions Routine vaccination of girls aged 12-13 years with the bivalent HPV vaccine in Scotland has led to a dramatic reduction in preinvasive cervical disease. Evidence of clinically relevant herd protection is apparent in unvaccinated women. These data are consistent with the reduced prevalence of high risk HPV in Scotland. The bivalent vaccine is confirmed as being highly effective vaccine and should greatly reduce the incidence of cervical cancer. The findings will need to be considered by cervical cancer prevention programmes worldwide.

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Section: Discussionmentioning

confidence: 99%

Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study

Palmer

Wallace

Pollock

et al. 2019

BMJ

166

168

View full text Add to dashboard Cite

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“…Once identified by screening, they lead to repeated examinations and overuse procedures, such as biopsies, colposcopies, and excisional techniques, with recognised obstetric morbidity [18, 19]. Even HSIL-CIN2 in young women seems to behave similarly to LSIL, with high rates of spontaneous regression [20, 21]. The reduction in the proportion of LSIL and HSIL-CIN2 results observed in our study, probably due to a decrease in the proportion of screened young women, indicates an improvement in program efficiency.…”

Section: Discussionmentioning

confidence: 99%

Estimating the public health impact of a national guideline on cervical cancer screening: an audit study of a program in Campinas, Brazil

et al. 2019

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BackgroundA Brazilian guideline on cervical cancer screening was released in 2011. The objective was to verify changes in screening indicators around this period.MethodsAn audit study which sample was all screening tests performed by the public health system of Campinas city from 2010 to 2016. Variables were absolute tests numbers, excess tests, intervals and results, by age. For trend analysis was used Cochran-Armitage × 2 and linear regression.ResultsWere carried out 62,925 tests in 2010 and 43,523 tests in 2016, a tendency at a reduction (P = 0.001). Excess tests were higher than 50% over the years, with a tendency at a reduction (P < 0.001). Tests performed on women under 25 ranged from 20.2 to 15.4% in the period (P < 0.001), while in the 25–64 years age-group, it ranged from 75.1 to 80.2% (P < 0.001). In 2010 the most frequent interval was annual (47.5%) and in 2016 biennial (34.7%). There was a tendency at a reduction in the proportion of tests performed at the first time and those with an annual interval (P < 0.001), and also a tendency at an increase in tests with intervals equal to or greater than biannual (P < 0.001). We observed a tendency at a reduction in LSIL and HSIL-CIN2 results (P = 0.04 and P = 0.001, respectively), and a tendency at an increase in HSIL-CIN3 result (P = 0.02).ConclusionThe proportion of cervical cancer screening tests performed out of the recommendation showed a significant reduction in the period. This indicates a tendency to align cervical cancer screening in Campinas with the standards recommended.

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“…36 The effectiveness of cervical cancer screening in younger women (<25 years old) is questionable because of the low incidence of cervical cancer, the higher incidence of false-positive screening tests, the high incidence of spontaneous resolution of precancerous lesions, and an increasing number of studies demonstrating a high rate of regression of HSILs (52.4%-71.1%). 36 In this retrospective cohort study, we examined the association of 1, 2, and ≥3 doses of the 4vHPV vaccine with cumulative incidence rates of histopathologically confirmed cervical intraepithelial neoplasia II/III (CIN-II/III) and high-grade cytology. High-grade cytology includes either an HSIL or atypical squamous cells, which cannot exclude a high-grade squamous intraepithelial lesion (ASC-H), in the United States.…”

Section: Introductionmentioning

confidence: 99%

“…More conservative management of high‐grade squamous intraepithelial lesions (HSILs) is now being advocated for younger women . The effectiveness of cervical cancer screening in younger women (<25 years old) is questionable because of the low incidence of cervical cancer, the higher incidence of false‐positive screening tests, the high incidence of spontaneous resolution of precancerous lesions, and an increasing number of studies demonstrating a high rate of regression of HSILs (52.4%‐71.1%) . In this retrospective cohort study, we examined the association of 1, 2, and ≥3 doses of the 4vHPV vaccine with cumulative incidence rates of histopathologically confirmed cervical intraepithelial neoplasia II/III (CIN‐II/III) and high‐grade cytology.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the long‐term impact and clinical outcomes of fewer doses and standard doses of human papillomavirus vaccine in the United States: A database study

Rodrı́guez

Zeybek

Vaughn

et al. 2020

Cancer

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Background Human papillomavirus (HPV)–related disease remains a significant source of morbidity and mortality, and this underscores the need to increase HPV vaccination to reduce the burden of the disease. The objective of this study was to examine the association between the number of HPV vaccine doses and the risk of histologically confirmed preinvasive cervical disease and high‐grade cytology. Methods This retrospective matched cohort study used administrative data from Optum's Clinformatics DataMart Database to identify females aged 9 to 26 years who received 1 or more quadrivalent HPV vaccine doses between January 2006 and June 2015. Cases and controls were matched on region, age, sexually transmitted disease history, and pregnancy. All had a Papanicolaou test ≥1 year after the date of the matched case's final dose. Cox proportional hazards models were used to examine the association between the number of HPV vaccine doses and the incidence of preinvasive cervical disease and high‐grade cytology. The Kaplan‐Meier method was used to estimate the cumulative incidence rate at the 5‐year follow‐up. Results The study included 133,082 females (66,541 vaccinated and 66,541 unvaccinated) stratified by the number of HPV vaccine doses and the vaccine initiation age. Among those aged 15 to 19 years, the hazard ratio (HR) for high‐grade cytology for the 3‐dose group was 0.84 (95% confidence interval [CI], 0.73‐0.97), whereas the HRs for histologically confirmed preinvasive cervical disease for 1, 2, and 3 doses were 0.64 (95% CI, 0.47‐0.88), 0.72 (95% CI, 0.54‐0.95), and 0.66 (95% CI, 0.55‐0.80), respectively. Conclusions The receipt of 1, 2, or 3 doses of an HPV vaccine by females aged 15 to 19 years was associated with a lower incidence of preinvasive cervical disease in comparison with unvaccinated females, and this supports the use of any HPV vaccination in reducing the burden of the disease.

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Outcomes of Conservative Management of High Grade Squamous Intraepithelial Lesions in Young Women

Cited by 34 publications

References 39 publications

Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study

Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study

Estimating the public health impact of a national guideline on cervical cancer screening: an audit study of a program in Campinas, Brazil

Comparison of the long‐term impact and clinical outcomes of fewer doses and standard doses of human papillomavirus vaccine in the United States: A database study

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