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Evidence summaries

HPV Vaccination and the Risk of Invasive Cervical Cancer

HPV vaccination given before the age of 17 appears to reduce risk of invasive cervical cancer. Level of evidence: "B"

The quality of evidence is upgraded by large magnitude of effect.

Summary

A study 1 using nationwide Swedish registers assessed the relationship between quadrivalent HPV vaccination and risk of invasive cervical cancer in a population of 1 672 983 girls and women who were 10 to 30 years of age from 2006 through 2017. After adjustment for age at follow-up, the incidence rate ratio for the comparison of the vaccinated population with the unvaccinated population was 0.51 (95% CI 0.32 to 0.82). After adjustment for all covariates, the incidence rate ratio was 0.12 (95% CI 0.00 to 0.34) among women who had been vaccinated before the age of 17 years and 0.47 (95% CI 0.27 to 0.75) among women who had been vaccinated at the age of 17 to 30 years.

A Cochrane review [Abstract] 2 included 26 trials with a total of 73 428 participants. In adolescent girls and women (aged 15 to 26) negative for hrHPV DNA at baseline, HPV vaccines reduce CIN2+, CIN3+, adenocarcinoma-in-situ (AIS) associated with HPV16/18 compared with placebo in adolescent girls and women (table T1). Studies were not of sufficient duration to evaluate cervical cancer outcomes.

HPV vaccine effects in adolescent girls and women negative for hrHPV DNA at baseline

OutcomeRelative effect(95% CI)RRRisk with placeboRisk with HPV vaccination (95% CI)of participants(studies)Certainty of evidence
CIN2+ associated with HPV16/18.Follow-up: 3 to 5 years0.01(0.00 to 0.05)164 per 10 0002 per 10 000(0 to 8)23 676(3) High
CIN3+ associated with HPV16/18.Follow-up: 3 to 5 years0.01(0.00 to 0.10)70 per 10 0000 per 10 000(0 to 7)20 214(2) High
Adenoca in situ associated with HPV16/18.Follow-up: 3 to 5 years0.10(0.01 to 0.82)9 per 10 0000 per 10 000(0 to 7)20 214(2) Moderate
Any CIN2+ irrespective of HPV type, bivalent or quadrivalent vaccineFollow-up: 2 to 6 years0.37(0.25 to 0.55)287 per 10 000106 per 10 000(72 to 158)25 180 (5) High
Any CIN3+ irrespective of HPV typeFollow-up (bivalent): 4 years0.08(0.03 to 0.23)81 per 10 0006 per 10 000(3 to 19)11 423(2) High
Any CIN3+ irrespective of HPV type Follow-up (quadrivalent): 3.5 yearsR0.54(0.36 to 0.82)143 per 10 00077 per 10 000(51 to 117 )9296(1) Moderate

Clinical comments

Note

Date of latest search: 2020-10-14

    References

    • Lei J, Ploner A, Elfström KM et al. HPV Vaccination and the Risk of Invasive Cervical Cancer. N Engl J Med 2020;383(14):1340-1348. [PubMed]
    • Arbyn M, Xu L, Simoens C et al. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database Syst Rev 2018;(5):CD009069. [PubMed]

Primary/Secondary Keywords