High-grade Cervical Lesions After Vaccination Against Human Papillomavirus: A Danish Cohort Study

Overview

Journal Acta Obstet Gynecol Scand

Publisher Wiley

Specialty Gynecology & Obstetrics

Date 2020 Aug 6

PMID 32754966

Citations 7

Authors

Lise Holst Thamsborg

George Napolitano

Lise Grupe Larsen

Elsebeth Lynge

Affiliations

Soon will be listed here.

Abstract

Introduction: It is pertinent to evaluate the impact of vaccination against human papillomavirus (HPV) in real life. The aim of the study was to evaluate the real-life impact of HPV vaccination in the first birth cohort of Danish women offered free HPV vaccination as girls and invited to screening at the age of 23 years.

Material And Methods: Women born in 1993 were offered free HPV vaccination at the age of 15 years but women born in 1983 have never been offered free HPV vaccination. We followed these two birth cohorts for 10 years from the age of 15 to after their first invitation to screening, and compared the risk of high-grade cervical intraepithelial neoplasia (CIN). Data were obtained from Danish national health registers.

Results: Vaccination coverage was 91% in the 1993 birth cohort and <0.1% in the 1983 cohort. Screening coverage was close to 80% in both cohorts. CIN2+ was detected in 4% of the 15 748 screened women born in 1983 and in 3% of the 19 951 screened women born in 1993. The risk of high-grade CIN was reduced by about 30% in the 1993 cohort compared with the 1983 cohort; for CIN2+ relative risk 0.74 (95% CI 0.66-0.82) and for CIN3+ relative risk 0.68 (95% CI 0.58-0.79).

Conclusions: This study investigated the real-life impact of quadrivalent HPV vaccination by comparing a cohort of women offered HPV vaccination with a cohort of women not offered HPV vaccination. The observed decrease in the detection of high-grade cervical lesions following HPV vaccination is in line with results from the randomized trials and has important implications for future cervical screening of HPV vaccinated cohorts.

Citing Articles

Impact of a national HPV vaccination programme for preadolescent girls on cytology screening performance and CIN2+ incidence: five-year population-based cervical screening results from Slovenia.

Irzaldy A, Jerman T, de Kok I, Hontelez J, de Koning H, Jansen E Lancet Reg Health Eur. 2025; 50():101203.

PMID: 39834615 PMC: 11743916. DOI: 10.1016/j.lanepe.2024.101203.

Post-marketing study design to evaluate the effectiveness of the 9-valent and 4-valent HPV vaccines on serious HPV-related cervical disease in China.

Yang Y, Zhang L, Hartwig S, Jiang P, Zhao H, Meng R Hum Vaccin Immunother. 2024; 20(1):2418168.

PMID: 39445828 PMC: 11508948. DOI: 10.1080/21645515.2024.2418168.

Predictable changes in the accuracy of human papillomavirus tests after vaccination: review with implications for performance monitoring in cervical screening.

Rebolj M, Brentnall A, Cuschieri K Br J Cancer. 2024; 130(11):1733-1743.

PMID: 38615108 PMC: 11130303. DOI: 10.1038/s41416-024-02681-z.

Implementation rate and related factors of confirmatory tests following an abnormal Pap smear: a nationwide study from the National Health Insurance.

Kim H, Kim K, Kim D, Hwang J J Gynecol Oncol. 2023; 35(3):e26.

PMID: 38130135 PMC: 11107272. DOI: 10.3802/jgo.2024.35.e26.

Long-Term Effects of Human Papillomavirus Vaccination in Clinical Trials and Real-World Data: A Systematic Review.

Kurosawa M, Sekine M, Yamaguchi M, Kudo R, Hanley S, Hara M Vaccines (Basel). 2022; 10(2).

PMID: 35214713 PMC: 8877934. DOI: 10.3390/vaccines10020256.

References

Mercer C, Tanton C, Prah P, Erens B, Sonnenberg P, Clifton S . Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet. 2013; 382(9907):1781-94. PMC: 3899021. DOI: 10.1016/S0140-6736(13)62035-8. View

Garland S, Hernandez-Avila M, Wheeler C, Perez G, Harper D, Leodolter S . Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007; 356(19):1928-43. DOI: 10.1056/NEJMoa061760. View

Bigaard J, Hariri J, Lynge E . Cervical cancer screening in Denmark. Eur J Cancer. 2000; 36(17):2198-204. DOI: 10.1016/s0959-8049(00)00309-9. View

Jensen K, Munk C, Sparen P, Tryggvadottir L, Liaw K, Dasbach E . Women's sexual behavior. Population-based study among 65,000 women from four Nordic countries before introduction of human papillomavirus vaccination. Acta Obstet Gynecol Scand. 2011; 90(5):459-67. DOI: 10.1111/j.1600-0412.2010.01066.x. View

Thamsborg L, Napolitano G, Larsen L, Lynge E . Impact of HPV vaccination on outcome of cervical cytology screening in Denmark-A register-based cohort study. Int J Cancer. 2018; 143(7):1662-1670. PMC: 6175001. DOI: 10.1002/ijc.31568. View

Hansen B, Kjaer S, Arnheim-Dahlstrom L, Liaw K, Juul K, Thomsen L . Age at first intercourse, number of partners and sexually transmitted infection prevalence among Danish, Norwegian and Swedish women: estimates and trends from nationally representative cross-sectional surveys of more than 100 000 women. Acta Obstet Gynecol Scand. 2019; 99(2):175-185. DOI: 10.1111/aogs.13732. View

Arbyn M, Xu L, Simoens C, Martin-Hirsch P . Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database Syst Rev. 2018; 5:CD009069. PMC: 6494566. DOI: 10.1002/14651858.CD009069.pub3. View

. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007; 356(19):1915-27. DOI: 10.1056/NEJMoa061741. View

Rask J, Lynge E, Franzmann M, Hansen B, Hjortebjerg A, Rygaard C . Impact of technology on cytology outcome in cervical cancer screening of young and older women. Int J Cancer. 2013; 134(9):2168-79. DOI: 10.1002/ijc.28532. View

10.

Palmer T, Wallace L, Pollock K, Cuschieri K, Robertson C, Kavanagh K . Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study. BMJ. 2019; 365:l1161. PMC: 6446188. DOI: 10.1136/bmj.l1161. View

11.

Munoz N, Kjaer S, Sigurdsson K, Iversen O, Hernandez-Avila M, Wheeler C . Impact of human papillomavirus (HPV)-6/11/16/18 vaccine on all HPV-associated genital diseases in young women. J Natl Cancer Inst. 2010; 102(5):325-39. DOI: 10.1093/jnci/djp534. View

12.

Thamsborg L, Napolitano G, Larsen L, Lynge E . High-grade cervical lesions after vaccination against human papillomavirus: A Danish cohort study. Acta Obstet Gynecol Scand. 2020; 99(10):1290-1296. PMC: 7540379. DOI: 10.1111/aogs.13935. View

13.

Sander B, Rebolj M, Valentiner-Branth P, Lynge E . Introduction of human papillomavirus vaccination in Nordic countries. Vaccine. 2011; 30(8):1425-33. DOI: 10.1016/j.vaccine.2011.11.097. View

14.

Lynge E, Rygaard C, Baillet M, Dugue P, Sander B, Bonde J . Cervical cancer screening at crossroads. APMIS. 2014; 122(8):667-73. DOI: 10.1111/apm.12279. View

15.

Olesen T, Jensen K, Munk C, Tolstrup J, Kjaer S . [''Liva"--population survey of female sexual habits]. Ugeskr Laeger. 2010; 172(47):3254-9. View

16.

Verdoodt F, Dehlendorff C, Kjaer S . Dose-related Effectiveness of Quadrivalent Human Papillomavirus Vaccine Against Cervical Intraepithelial Neoplasia: A Danish Nationwide Cohort Study. Clin Infect Dis. 2019; 70(4):608-614. DOI: 10.1093/cid/ciz239. View

17.

Barken S, Rebolj M, Lynge E, Junge J, Rygaard C . Outcomes in cervical screening using various cytology technologies: what's age got to do with it?. Eur J Cancer Prev. 2012; 22(4):367-73. DOI: 10.1097/CEJ.0b013e328359cbe0. View

18.

Guleria S, Juul K, Munk C, Hansen B, Arnheim-Dahlstrom L, Liaw K . Contraceptive non-use and emergency contraceptive use at first sexual intercourse among nearly 12 000 Scandinavian women. Acta Obstet Gynecol Scand. 2016; 96(3):286-294. DOI: 10.1111/aogs.13088. View

19.

Drolet M, Benard E, Perez N, Brisson M . Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet. 2019; 394(10197):497-509. PMC: 7316527. DOI: 10.1016/S0140-6736(19)30298-3. View

20.

Herweijer E, Sundstrom K, Ploner A, Uhnoo I, Sparen P, Arnheim-Dahlstrom L . Quadrivalent HPV vaccine effectiveness against high-grade cervical lesions by age at vaccination: A population-based study. Int J Cancer. 2016; 138(12):2867-74. PMC: 5069657. DOI: 10.1002/ijc.30035. View