Abstract
Background: Recent studies have shown preliminary evidence that vaccination against human papillomavirus (HPV) could decrease the risk of persistent/recurrent HSIL in women treated for high-grade cervical intraepithelial lesion (HSIL). We aimed to determine the benefits of HPV vaccination in patients undergoing conization for HSIL in real-life conditions and evaluate vaccination compliance associated with different funding policies. Methods: From January 2013 to July 2018, 265 women underwent conization in our center. From January 2013 to July 2017, treated patients (n = 131) had to pay for the vaccine, whereas after July 2017 the vaccine was publicly funded and free for treated women (n = 134). Post-conization follow-up controls were scheduled every six months with a Pap smear, HPV testing, and a colposcopy. Results: 153 (57.7%) women accepted vaccination (vaccinated group), and 112 (42.3%) refused the vaccine (non-vaccinated group). Persistent/recurrent HSIL was less frequent in vaccinated than in non-vaccinated women (3.3% vs. 10.7%, p = 0.015). HPV vaccination was associated with a reduced risk of persistent/recurrent HSIL (OR 0.2, 95%CI: 0.1–0.7, p = 0.010). Vaccination compliance increased when the vaccine was publicly funded (from 35.9% [47/131] to 79.1% [106/134], p < 0.001). Conclusions: HPV vaccination in women undergoing conization is associated with a 4.5-fold reduction in the risk of persistent/recurrent HSIL. Vaccination policies have an important impact on vaccination compliance.
Highlights
Women with high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade2–3 (HSIL/CIN2-3) are treated by excisional procedure or ablation to prevent progression to cervical cancer [1]
One 26-year-old woman with HSIL/CIN2-3 had a one woman rejected a second treatment and showed persistent LSIL/human papillomavirus (HPV) during the follow-up, normal colposcopy. She was not treated and in the follow-up controls showed persistent HPV with one woman showed HSIL/CIN2-3 biopsy with a negative HPV test and underwent follow-up visits no cytological or histological abnormalities, which persisted at the end of the follow-up showing no disease at 18 months post-treatment
The present series provides further evidence confirming the clinical benefits of HPV vaccination as an adjuvant to excision treatment for HSIL in real-life conditions, showing that
Summary
Women with high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade2–3 (HSIL/CIN2-3) are treated by excisional procedure (conization) or ablation to prevent progression to cervical cancer [1]. Persistent/recurrent disease occurs in 5–15% of the women treated for HSIL/CIN2-3 [2,3] These women are at higher risk of cervical cancer compared with the general population, even after adequate treatment [4,5,6,7]. Persistent human papilloma virus (HPV) infection after treatment, with or without residual HSIL/CIN2-3, is clearly the most important established risk factor [11]. Another possible mechanism is the acquisition of a new HPV infection, since women who have already developed HSIL/CIN2-3 have shown an increased risk of developing new HPV-associated lesions [12].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
