The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: England NLM ID: 2985213R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1474-547X (Electronic) Linking ISSN: 01406736 NLM ISO Abbreviation: Lancet Subsets: MEDLINE
    • Publication Information:
      Publication: 2004- : London : Elsevier
      Original Publication: London : J. Onwhyn
    • Subject Terms:
      Early Detection of Cancer* ; Incidence*; Papillomavirus Infections/*prevention & control ; Papillomavirus Vaccines/*administration & dosage ; Uterine Cervical Neoplasms/*epidemiology ; Uterine Cervical Dysplasia/*epidemiology; Adolescent ; Adult ; Child ; England/epidemiology ; Female ; Humans ; Immunization ; Middle Aged ; Registries ; Uterine Cervical Neoplasms/diagnosis ; Uterine Cervical Neoplasms/virology ; Vaccination ; Uterine Cervical Dysplasia/diagnosis ; Uterine Cervical Dysplasia/virology
    • Abstract:
      Background: Human papillomavirus (HPV) immunisation with a bivalent vaccine (Cervarix) was introduced in England, UK, in Sept 1, 2008: routine vaccination was offered to girls aged 12-13 years with a catch-up programme for females aged 14-18 years in 2008-10. We quantified the early effect of this immunisation programme on cervical cancer and cervical carcinoma in situ, namely grade 3 cervical intraepithelial neoplasia (CIN3), registrations.
      Methods: In this observational study, we used an extension of the age-period-cohort Poisson model to estimate the relative risk of cervical cancer in three vaccinated cohorts compared with earlier cohorts that were not eligible for HPV vaccination. Data from a population-based cancer registry were extracted on Jan 26, 2021, and were assessed for diagnoses of cervical cancer and CIN3 from Jan 1, 2006 to June 30, 2019 in women aged 20-64 years and who were a resident in England. We used three vaccinated cohorts to account for differences in the school year in which the vaccine was offered and its national coverage. Adjustment for confounding was made using information on changes in cervical screening policy and historical events that affected cervical cancer incidence. Results were compared across models with different adjustments for confounders.
      Findings: We used data from a total of 13·7 million-years of follow-up of women aged 20 years to younger than 30 years. The estimated relative reduction in cervical cancer rates by age at vaccine offer were 34% (95% CI 25-41) for age 16-18 years (school year 12-13), 62% (52-71) for age 14-16 years (school year 10-11), and 87% (72-94) for age 12-13 years (school year 8), compared with the reference unvaccinated cohort. The corresponding risk reductions for CIN3 were 39% (95% CI 36-41) for those offered at age 16-18 years, 75% (72-77) for age 14-16 years, and 97% (96-98) for age 12-13 years. These results remained similar across models. We estimated that by June 30, 2019 there had been 448 (339-556) fewer than expected cervical cancers and 17 235 (15 919-18 552) fewer than expected cases of CIN3 in vaccinated cohorts in England.
      Interpretation: We observed a substantial reduction in cervical cancer and incidence of CIN3 in young women after the introduction of the HPV immunisation programme in England, especially in individuals who were offered the vaccine at age 12-13 years. The HPV immunisation programme has successfully almost eliminated cervical cancer in women born since Sept 1, 1995.
      Funding: Cancer Research UK.
      Competing Interests: Declaration of interests We declare no competing interests.
      (Crown Copyright © 2021 Published by Elsevier Ltd. All rights reserved.)
    • Comments:
      Comment in: Lancet. 2021 Dec 4;398(10316):2053-2055. (PMID: 34741814)
      Comment in: Lancet. 2022 May 21;399(10339):1939-1940. (PMID: 35598620)
      Comment in: Lancet. 2022 May 21;399(10339):1939. (PMID: 35598621)
      Comment in: Lancet Oncol. 2023 Sep;24(9):955. (PMID: 37517408)
    • Grant Information:
      25356 United Kingdom CRUK_ Cancer Research UK; 27047 United Kingdom CRUK_ Cancer Research UK
    • Accession Number:
      0 (Papillomavirus Vaccines)
      0 (human papillomavirus vaccine, L1 type 16, 18)
    • Publication Date:
      Date Created: 20211106 Date Completed: 20220107 Latest Revision: 20240210
    • Publication Date:
      20240210
    • Accession Number:
      10.1016/S0140-6736(21)02178-4
    • Accession Number:
      34741816