title: Impact of human papillomavirus vaccination on cervical cytology screening, colposcopy, and treatment.
abstract: The impact of human papillomavirus (HPV) vaccination on cervical screening, colposcopy, and treatment is incompletely understood. In 2004-2005, investigators in the Costa Rica Vaccine Trial randomized 7,466 women aged 18-25 years, 1:1, to receive HPV vaccination or hepatitis A vaccination. The worst-ever cytology diagnosis and the 4-year cumulative proportions of colposcopy referral and treatment by vaccination arm were compared for 2 cohorts. The total vaccinated cohort included 6,844 women who provided cervical samples. The naive cohort included 2,284 women with no evidence of previous HPV exposure. In the total vaccinated cohort, HPV-vaccinated women had a significant (P = 0.01) reduction in cytological abnormalities: 12.4% for high-grade lesions and 5.9% for minor lesions. Colposcopy referral was reduced by 7.9% (P = 0.03) and treatment by 11.3% (P = 0.24). Greater relative reductions in abnormal cytology (P < 0.001) were observed for HPV-vaccinated women in the naive cohort: 49.2% for high-grade lesions and 18.1% for minor lesions. Colposcopy referral and treatment were reduced by 21.3% (P = 0.01) and 45.6% (P = 0.08), respectively, in the naive cohort. The overall impact on health services will be modest in the first years after vaccine introduction among young adult women, even in regions with high coverage.
authors.affiliation: Guanacaste Epidemiology Project, INCIENSA Foundation, Torre La Sabana, Planta Baja, Sabana Norte, San José, Costa Rica. acrodriguez@racsa.co.cr
authors.forename: Ana Cecilia
authors.initials: AC
authors.lastname: Rodríguez
authors.forename: Diane
authors.initials: D
authors.lastname: Solomon
authors.forename: Rolando
authors.initials: R
authors.lastname: Herrero
authors.forename: Allan
authors.initials: A
authors.lastname: Hildesheim
authors.forename: Paula
authors.initials: P
authors.lastname: González
authors.forename: Sholom
authors.initials: S
authors.lastname: Wacholder
authors.forename: Carolina
authors.initials: C
authors.lastname: Porras
authors.forename: Silvia
authors.initials: S
authors.lastname: Jiménez
authors.forename: Mark
authors.initials: M
authors.lastname: Schiffman
mesh_terms: D003127:Colposcopy / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D022362:Hepatitis A Vaccines / Q000008:administration & dosage; D006801:Humans; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D014626:Vaginal Smears / Q000706:statistics & numerical data*
chemical_list: D022362:Hepatitis A Vaccines; D053918:Papillomavirus Vaccines
keywords: HPV; HPV vaccination; cervical cancer; human papillomavirus; screening