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

Christopher A Paynter,Benjamin J Van Treeck,Inge Verdenius,Agnes W.Y Lau,Twinkle Dhawan,Kayla A Lash,Elizabeth A Bergamini,Chiazotam N Ekekezie,Amna M Hilal,Kristen N James,Sadie Alongi,Sean M Harper,Aaron J Bonham,Kathy B Baumgartner,Richard N Baumgartner,Diane M Harper

doi:10.1016/j.pmedr.2015.07.011

Abstract

Cervical cancer screening has reduced the incidence of cervical cancer over the past 75years. 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 14–26years 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 21years and received three vaccine doses before 21years, had the lowest screening rate of 24%. Their only predictive factor for screening, compared to the unvaccinated, was being closer to 21years than 14years at vaccination (aOR=1.71 95% CI: 1.45, 2.00). Women vaccinated with three doses and screened at or after 21years 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 21years, not 14, are more likely to participate in cervical cancer screening in an underserved US population.

Highlights

The primary aim of this study was to determine if women receiving GardasilTM (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
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
In this retrospective cohort study, subjects were selected from the 27,786 young women aged 14–26 years of age seen in the Truman Medical Center (TMC) safety net health care system in Kansas City, MO, USA between July 1, 2006 and October 1, 2009, and followed through July 1, 2013, when the youngest vaccinated would be at 21 years of age, the US recommended screening age

Summary

Introduction

Women at the highest risk for cervical cancer are those who are underserved and uninsured, and who seek care in the safety net health care system (Lewin, 2000; Freeman and Wingrove, 2005). By understanding women's behavior in high-risk populations after HPV vaccination towards future cervical cancer screening participation, we may be able to reduce cervical cancer and its associated vulnerabilities (Freeman and Wingrove, 2005). The primary aim of this study was to determine if HPV4 vaccination was a predictor of adherence to cervical cancer screening in an underserved population. The secondary aim is to explore whether HPV4 vaccination predicts whether women with NILM screen results continue to participate in routine screening

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Conclusion