title: Human papillomavirus vaccination and Pap testing profile in Manitoba, Canada.
abstract: BACKGROUND
  Females who receive the human papillomavirus (HPV) vaccine may believe they are protected from developing cervical cancer and no longer require screening. Concern has also been expressed that vaccinated females are those that would be screened regularly. This study assesses the Pap testing behavior of vaccinated and non-vaccinated females.
  
  
  METHODS
  For this population-based retrospective cohort study, vaccination and screening registries were linked for 3540 vaccinated females aged 15 years and over and 9592 matched non-vaccinated females. Conditional logistic regression, the Kaplan-Meier method and Cox regression were used to examine the association between vaccination and Pap testing.
  
  
  RESULTS
  Vaccinated females were more likely to have had a Pap test within the year prior to the index date than non-vaccinated females (15-19 years old: OR=1.38, 95% CI 1.20-1.59; 20+ years old: OR=2.34, 95% CI 1.98-2.76). In the three-year period after the index date, vaccinated females had a significantly higher cumulative probability of having a Pap test (83.3%) than non-vaccinated females (66.1%). Females who had a Pap test within three years prior to the index date were more likely to have a Pap test after the index date (vaccinated: HR=5.03, 95% CI 4.65-5.45; non-vaccinated HR=3.97, 95% CI 3.70-4.24). Being vaccinated had a significant effect on Pap testing (15-19 years old: HR=1.54, 95% CI 1.39-1.69; 20+ years old: HR=1.87, 95% CI 1.52-2.31). 80.1% of vaccinated females who had a Pap test prior to the index date also had one subsequent to it, compared to 70.1% for non-vaccinated females. 41.1% of females had not been vaccinated nor had a Pap test.
  
  
  CONCLUSIONS
  The majority of vaccinated females continue to participate in screening, and do so at a higher rate than non-vaccinated females. Renewed efforts need to be made to include the large proportion of non-vaccinated, non-screened females in vaccination and/or screening.
authors.affiliation: Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC, Canada. Electronic address: ekliewer@bccrc.ca.
authors.forename: Erich V
authors.initials: EV
authors.lastname: Kliewer
authors.affiliation: Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: smahmud@wrha.mb.ca.
authors.forename: Salaheddin M
authors.initials: SM
authors.lastname: Mahmud
authors.affiliation: Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: Alain.Demers@cancercare.mb.ca.
authors.forename: Alain A
authors.initials: AA
authors.lastname: Demers
authors.affiliation: Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada. Electronic address: Pascal.Lambert@cancercare.mb.ca.
authors.forename: Pascal
authors.initials: P
authors.lastname: Lambert
mesh_terms: D000293:Adolescent; D000328:Adult; D052685:Alphapapillomavirus / Q000276:immunology*; D005260:Female; D006801:Humans; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000276:immunology*; D011159:Population Surveillance; D012042:Registries; D012189:Retrospective Studies; D014611:Vaccination / Q000706:statistics & numerical data*; D014626:Vaginal Smears; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer; Human papillomavirus (HPV); Pap test; Screening; Vaccination