Impact of HPV vaccination on cervical screening performance: a population-based cohort study
Background Human papillomavirus (HPV) vaccination is predicted to lower the positive predictive value (PPV) of cytology. Methods We included 153,250 girls born between 1989 and 1993, resident in Sweden since the introduction of HPV vaccines (October 2006) and attending cervical screening at age 23 y...
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| Veröffentlicht in: | British journal of cancer 2020-07, Vol.123 (1), p.155-160 |
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| creator | Lei, Jiayao Ploner, Alexander Lehtinen, Matti Sparén, Pär Dillner, Joakim Elfström, K. Miriam |
| description | Background
Human papillomavirus (HPV) vaccination is predicted to lower the positive predictive value (PPV) of cytology.
Methods
We included 153,250 girls born between 1989 and 1993, resident in Sweden since the introduction of HPV vaccines (October 2006) and attending cervical screening at age 23 years. We assessed their first cytology and following histopathological diagnosis using Swedish National Cervical Screening Registry (NKCx). By linkage with the national Swedish HPV vaccination registry, we determined PPV of abnormal cytology for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and the differences with 95% confidence intervals (CIs) according to vaccination status.
Results
The PPV of high-grade cytology for CIN2+ was 69.9% (95% CI, 67.9–71.9), 64.9% (95% CI, 59.8–69.8) and 57.4% (95% CI, 50.9–63.7) among women unvaccinated, initiating vaccination at age 17–22 years and initiating vaccination before age 17 years, corresponding to reduction in PPV by 8% (95% CI, 0–15%) and 17% (95% CI, 7–26%) in vaccinated groups after adjustment for birth cohort, respectively.
Conclusion
The PPV of cytology for CIN2+ decreased among vaccinated women, and the decrease was stronger for girls vaccinated at younger ages. A switch from cytology to HPV testing might potentially improve the screening performance. |
| doi_str_mv | 10.1038/s41416-020-0850-6 |
| format | Article |
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Human papillomavirus (HPV) vaccination is predicted to lower the positive predictive value (PPV) of cytology.
Methods
We included 153,250 girls born between 1989 and 1993, resident in Sweden since the introduction of HPV vaccines (October 2006) and attending cervical screening at age 23 years. We assessed their first cytology and following histopathological diagnosis using Swedish National Cervical Screening Registry (NKCx). By linkage with the national Swedish HPV vaccination registry, we determined PPV of abnormal cytology for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and the differences with 95% confidence intervals (CIs) according to vaccination status.
Results
The PPV of high-grade cytology for CIN2+ was 69.9% (95% CI, 67.9–71.9), 64.9% (95% CI, 59.8–69.8) and 57.4% (95% CI, 50.9–63.7) among women unvaccinated, initiating vaccination at age 17–22 years and initiating vaccination before age 17 years, corresponding to reduction in PPV by 8% (95% CI, 0–15%) and 17% (95% CI, 7–26%) in vaccinated groups after adjustment for birth cohort, respectively.
Conclusion
The PPV of cytology for CIN2+ decreased among vaccinated women, and the decrease was stronger for girls vaccinated at younger ages. A switch from cytology to HPV testing might potentially improve the screening performance.</description><identifier>ISSN: 0007-0920</identifier><identifier>EISSN: 1532-1827</identifier><identifier>DOI: 10.1038/s41416-020-0850-6</identifier><identifier>PMID: 32362659</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/308/174 ; 692/699/67 ; Adolescent ; Adult ; Age ; Biomedical and Life Sciences ; Biomedicine ; Cancer Research ; Cellular biology ; Cervical Intraepithelial Neoplasia - epidemiology ; Cervical Intraepithelial Neoplasia - immunology ; Cervical Intraepithelial Neoplasia - prevention & control ; Cervical Intraepithelial Neoplasia - virology ; Cervix Uteri - pathology ; Cervix Uteri - virology ; Cohort analysis ; Cohort Studies ; Colposcopy ; Cytology ; Drug Resistance ; Early Detection of Cancer ; Epidemiology ; Female ; Human papillomavirus ; Human papillomavirus 16 - pathogenicity ; Human papillomavirus 18 - pathogenicity ; Humans ; Immunization ; Medical screening ; Middle Aged ; Molecular Medicine ; Oncology ; Papillomavirus Infections - epidemiology ; Papillomavirus Infections - pathology ; Papillomavirus Infections - prevention & control ; Papillomavirus Infections - virology ; Papillomavirus Vaccines ; Population studies ; Population-based studies ; Pregnancy ; Sweden - epidemiology ; Uterine Cervical Neoplasms - epidemiology ; Uterine Cervical Neoplasms - immunology ; Uterine Cervical Neoplasms - prevention & control ; Uterine Cervical Neoplasms - virology ; Vaccination - methods ; Young Adult</subject><ispartof>British journal of cancer, 2020-07, Vol.123 (1), p.155-160</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-2472d8f1ba7e21a8a208579ad1345c06ca8335ba0fa84235bb0d694118a8bdee3</citedby><cites>FETCH-LOGICAL-c508t-2472d8f1ba7e21a8a208579ad1345c06ca8335ba0fa84235bb0d694118a8bdee3</cites><orcidid>0000-0002-4718-1414</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7341799/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7341799/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,550,723,776,780,881,27901,27902,41464,42533,51294,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32362659$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:143571640$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Lei, Jiayao</creatorcontrib><creatorcontrib>Ploner, Alexander</creatorcontrib><creatorcontrib>Lehtinen, Matti</creatorcontrib><creatorcontrib>Sparén, Pär</creatorcontrib><creatorcontrib>Dillner, Joakim</creatorcontrib><creatorcontrib>Elfström, K. Miriam</creatorcontrib><title>Impact of HPV vaccination on cervical screening performance: a population-based cohort study</title><title>British journal of cancer</title><addtitle>Br J Cancer</addtitle><addtitle>Br J Cancer</addtitle><description>Background
Human papillomavirus (HPV) vaccination is predicted to lower the positive predictive value (PPV) of cytology.
Methods
We included 153,250 girls born between 1989 and 1993, resident in Sweden since the introduction of HPV vaccines (October 2006) and attending cervical screening at age 23 years. We assessed their first cytology and following histopathological diagnosis using Swedish National Cervical Screening Registry (NKCx). By linkage with the national Swedish HPV vaccination registry, we determined PPV of abnormal cytology for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and the differences with 95% confidence intervals (CIs) according to vaccination status.
Results
The PPV of high-grade cytology for CIN2+ was 69.9% (95% CI, 67.9–71.9), 64.9% (95% CI, 59.8–69.8) and 57.4% (95% CI, 50.9–63.7) among women unvaccinated, initiating vaccination at age 17–22 years and initiating vaccination before age 17 years, corresponding to reduction in PPV by 8% (95% CI, 0–15%) and 17% (95% CI, 7–26%) in vaccinated groups after adjustment for birth cohort, respectively.
Conclusion
The PPV of cytology for CIN2+ decreased among vaccinated women, and the decrease was stronger for girls vaccinated at younger ages. A switch from cytology to HPV testing might potentially improve the screening performance.</description><subject>692/308/174</subject><subject>692/699/67</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Cancer Research</subject><subject>Cellular biology</subject><subject>Cervical Intraepithelial Neoplasia - epidemiology</subject><subject>Cervical Intraepithelial Neoplasia - immunology</subject><subject>Cervical Intraepithelial Neoplasia - prevention & control</subject><subject>Cervical Intraepithelial Neoplasia - virology</subject><subject>Cervix Uteri - pathology</subject><subject>Cervix Uteri - virology</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Colposcopy</subject><subject>Cytology</subject><subject>Drug Resistance</subject><subject>Early Detection of Cancer</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Human papillomavirus</subject><subject>Human papillomavirus 16 - pathogenicity</subject><subject>Human papillomavirus 18 - pathogenicity</subject><subject>Humans</subject><subject>Immunization</subject><subject>Medical screening</subject><subject>Middle Aged</subject><subject>Molecular Medicine</subject><subject>Oncology</subject><subject>Papillomavirus Infections - epidemiology</subject><subject>Papillomavirus Infections - pathology</subject><subject>Papillomavirus Infections - prevention & control</subject><subject>Papillomavirus Infections - virology</subject><subject>Papillomavirus Vaccines</subject><subject>Population studies</subject><subject>Population-based studies</subject><subject>Pregnancy</subject><subject>Sweden - epidemiology</subject><subject>Uterine Cervical Neoplasms - epidemiology</subject><subject>Uterine Cervical Neoplasms - immunology</subject><subject>Uterine Cervical Neoplasms - prevention & control</subject><subject>Uterine Cervical Neoplasms - virology</subject><subject>Vaccination - methods</subject><subject>Young Adult</subject><issn>0007-0920</issn><issn>1532-1827</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>D8T</sourceid><recordid>eNp1kd9rFDEQx4Mo9lr9A3yRgC--RDPJ_sj6IJRibaGgD-qTEGazs9ete8ma7J70vzfnndUKQiCTzGe-ycyXsWcgX4HU5nUqoIBKSCWFNKUU1QO2glIrAUbVD9lKSlkL2Sh5xI5TusnHRpr6MTvSSleqKpsV-3q5mdDNPPT84uMXvkXnBo_zEDzPy1HcDg5Hnlwk8oNf84liH-IGvaM3HPkUpmX8xYsWE3XchesQZ57mpbt9wh71OCZ6ethP2Ofzd5_OLsTVh_eXZ6dXwpXSzEIVtepMDy3WpAANqtxN3WAHuiidrBwarcsWZY-mUDlqZVc1BYBB03ZE-oSJvW76QdPS2ikOG4y3NuBgD1ffckS2qCELZ_7tns-ZDXWO_BxxvFd2P-OHa7sOW1vrAupmJ_DyIBDD94XSbDdDcjSO6CksySrdGChL1UBGX_yD3oQl-jwOqwqVDQEDOwr2lIshpUj93WdA2p3Xdu-1zV7bnde2yjXP_-7iruK3uRlQh7HklF9T_PP0_1V_AlSUtb4</recordid><startdate>20200707</startdate><enddate>20200707</enddate><creator>Lei, Jiayao</creator><creator>Ploner, Alexander</creator><creator>Lehtinen, Matti</creator><creator>Sparén, Pär</creator><creator>Dillner, Joakim</creator><creator>Elfström, K. Miriam</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TO</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0002-4718-1414</orcidid></search><sort><creationdate>20200707</creationdate><title>Impact of HPV vaccination on cervical screening performance: a population-based cohort study</title><author>Lei, Jiayao ; Ploner, Alexander ; Lehtinen, Matti ; Sparén, Pär ; Dillner, Joakim ; Elfström, K. Miriam</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-2472d8f1ba7e21a8a208579ad1345c06ca8335ba0fa84235bb0d694118a8bdee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>692/308/174</topic><topic>692/699/67</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Age</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Cancer Research</topic><topic>Cellular biology</topic><topic>Cervical Intraepithelial Neoplasia - epidemiology</topic><topic>Cervical Intraepithelial Neoplasia - immunology</topic><topic>Cervical Intraepithelial Neoplasia - prevention & control</topic><topic>Cervical Intraepithelial Neoplasia - virology</topic><topic>Cervix Uteri - pathology</topic><topic>Cervix Uteri - virology</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Colposcopy</topic><topic>Cytology</topic><topic>Drug Resistance</topic><topic>Early Detection of Cancer</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Human papillomavirus</topic><topic>Human papillomavirus 16 - pathogenicity</topic><topic>Human papillomavirus 18 - pathogenicity</topic><topic>Humans</topic><topic>Immunization</topic><topic>Medical screening</topic><topic>Middle Aged</topic><topic>Molecular Medicine</topic><topic>Oncology</topic><topic>Papillomavirus Infections - epidemiology</topic><topic>Papillomavirus Infections - pathology</topic><topic>Papillomavirus Infections - prevention & control</topic><topic>Papillomavirus Infections - virology</topic><topic>Papillomavirus Vaccines</topic><topic>Population studies</topic><topic>Population-based studies</topic><topic>Pregnancy</topic><topic>Sweden - epidemiology</topic><topic>Uterine Cervical Neoplasms - epidemiology</topic><topic>Uterine Cervical Neoplasms - immunology</topic><topic>Uterine Cervical Neoplasms - prevention & control</topic><topic>Uterine Cervical Neoplasms - virology</topic><topic>Vaccination - methods</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lei, Jiayao</creatorcontrib><creatorcontrib>Ploner, Alexander</creatorcontrib><creatorcontrib>Lehtinen, Matti</creatorcontrib><creatorcontrib>Sparén, Pär</creatorcontrib><creatorcontrib>Dillner, Joakim</creatorcontrib><creatorcontrib>Elfström, K. 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Miriam</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of HPV vaccination on cervical screening performance: a population-based cohort study</atitle><jtitle>British journal of cancer</jtitle><stitle>Br J Cancer</stitle><addtitle>Br J Cancer</addtitle><date>2020-07-07</date><risdate>2020</risdate><volume>123</volume><issue>1</issue><spage>155</spage><epage>160</epage><pages>155-160</pages><issn>0007-0920</issn><eissn>1532-1827</eissn><abstract>Background
Human papillomavirus (HPV) vaccination is predicted to lower the positive predictive value (PPV) of cytology.
Methods
We included 153,250 girls born between 1989 and 1993, resident in Sweden since the introduction of HPV vaccines (October 2006) and attending cervical screening at age 23 years. We assessed their first cytology and following histopathological diagnosis using Swedish National Cervical Screening Registry (NKCx). By linkage with the national Swedish HPV vaccination registry, we determined PPV of abnormal cytology for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and the differences with 95% confidence intervals (CIs) according to vaccination status.
Results
The PPV of high-grade cytology for CIN2+ was 69.9% (95% CI, 67.9–71.9), 64.9% (95% CI, 59.8–69.8) and 57.4% (95% CI, 50.9–63.7) among women unvaccinated, initiating vaccination at age 17–22 years and initiating vaccination before age 17 years, corresponding to reduction in PPV by 8% (95% CI, 0–15%) and 17% (95% CI, 7–26%) in vaccinated groups after adjustment for birth cohort, respectively.
Conclusion
The PPV of cytology for CIN2+ decreased among vaccinated women, and the decrease was stronger for girls vaccinated at younger ages. A switch from cytology to HPV testing might potentially improve the screening performance.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>32362659</pmid><doi>10.1038/s41416-020-0850-6</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-4718-1414</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | 692/308/174 692/699/67 Adolescent Adult Age Biomedical and Life Sciences Biomedicine Cancer Research Cellular biology Cervical Intraepithelial Neoplasia - epidemiology Cervical Intraepithelial Neoplasia - immunology Cervical Intraepithelial Neoplasia - prevention & control Cervical Intraepithelial Neoplasia - virology Cervix Uteri - pathology Cervix Uteri - virology Cohort analysis Cohort Studies Colposcopy Cytology Drug Resistance Early Detection of Cancer Epidemiology Female Human papillomavirus Human papillomavirus 16 - pathogenicity Human papillomavirus 18 - pathogenicity Humans Immunization Medical screening Middle Aged Molecular Medicine Oncology Papillomavirus Infections - epidemiology Papillomavirus Infections - pathology Papillomavirus Infections - prevention & control Papillomavirus Infections - virology Papillomavirus Vaccines Population studies Population-based studies Pregnancy Sweden - epidemiology Uterine Cervical Neoplasms - epidemiology Uterine Cervical Neoplasms - immunology Uterine Cervical Neoplasms - prevention & control Uterine Cervical Neoplasms - virology Vaccination - methods Young Adult |
| title | Impact of HPV vaccination on cervical screening performance: a population-based cohort study |
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