Abstract
BackgroundHuman papillomavirus (HPV) vaccination is predicted to lower the positive predictive value (PPV) of cytology.MethodsWe 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.ResultsThe 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.ConclusionThe 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.
Highlights
Human papillomavirus (HPV) vaccination is predicted to lower the positive predictive value (PPV) of cytology
The total HPV vaccination coverage was below 10% for birth cohorts vaccinated through self-paid opportunistic vaccination (1985–1988)
The decreases of PPV corresponds to the reduced detection rates of CIN2+ in HPV-vaccinated compared to unvaccinated women, and the reduction was stronger for women initiating vaccination earlier
Summary
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. Strongest effectiveness has been seen in girls initiating vaccination before age 17 years, with 64% effectiveness against CIN2+.4,5 Vaccination provides some cross-protection against HPV types not included in the vaccines.[8,9,10]
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