Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

HPV Vaccination and Cervical Cancer Screening

Clin Infect Dis; ePub 2018 Aug 23; Gargano, et al

Publish date:

Both cervical intraepithelial neoplasia grades 2, 3 and adenocarcinoma in situ (CIN2+) rates plus cervical cancer screening declined in young women from 2008-2015 and are consistent with population-level impact of human papillomavirus (HPV) vaccination. Researchers conducted population-based laboratory surveillance for CIN2+ in catchment areas in 5 states from 2008-2015 and estimate the annual proportion of population receiving cervical cancer screening. They also calculated population-based CIN2+ rates per 100,000 women by age group and estimated incidence rate ratios (IRR) of CIN2+ for 2-year periods among all women and in the estimated screened population to evaluate changes over time. They found:

  • 16,572 CIN2+ cases were reported.
  • Among women aged 18-20 and 21-24 years, CIN2+ rates declined in all sites.
  • The percentage of women screened annually declined in all sites and age groups.
  • Compared to 2008-2009, rates among screened women were significantly lower for all 3 periods in women aged 18-20 years and lower for the latter 2 time periods in women aged 21-24 years.
  • The significant decreases in CIN2+ rates among screened women aged 18-24 years are consistent with population-level impact of HPV vaccination.

Citation:

Gargano JW, Park IU, Griffin MR, et al. Trends in high-grade cervical lesions and cervical cancer screening in five states, 2008–2015. [Published online ahead of print August 23, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy707.

Commentary:

The HPV vaccine should be viewed as a vaccine to decrease the incidence of cancer. There are about 27,000 cases of cancers related to HPV annually. This study shows that there are some inroads being made through our vaccination programs of girls and boys. We no longer do routine cervical cytology on those under 21 years of age. We should offer this to all teenagers in the context of decreasing the rates of these cancers and less about the rate of decreasing sexually transmitted infections. — John Russell, MD

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