title: HPV immunisation and increased uptake of cervical screening in Scottish women; observational study of routinely collected national data.
abstract: BACKGROUND
  To measure the uptake of first invitation to cervical screening by vaccine status in a population-based cohort offered HPV immunisation in a national catch-up campaign.
  
  
  METHODS
  A retrospective observational study of routinely collected data from the Scottish Cervical Screening Programme. Data were extracted and linked from the Scottish Cervical Call Recall System, the Scottish Population Register and the Scottish Index of Multiple Deprivation. Records from 201 023 women born between 1 January 1988 and 30 September 1993 were assessed. Women born in or after 1990 were eligible for the national catch-up programme of HPV immunisation. Attendance for screening was within 12 months of the first invitation at age 20 years.
  
  
  RESULTS
  There was a significant decline in overall attendance from the 1988 cohort to the 1993 cohort with the adjusted attendance ratio of the 1988 cohort being 1.49 times (95% CI 1.46-1.52) that of the 1993 cohort. Immunisation compensated for this decrease in uptake with unvaccinated individuals having a reduced ratio of attendance compared with those fully vaccinated (RR=0.65, 95% CI 0.64-0.65). Not taking up the opportunity for HPV immunisation was associated with an attendance for screening below the trend line for all women before the availability of HPV immunisation.
  
  
  CONCLUSIONS
  HPV immunisation is not associated with the reduced attendance for screening that had been feared. Immunised women in the catch-up cohorts appear to be more motivated to attend than unimmunised women, but this may be a result of a greater awareness of health issues. These results, while reassuring, may not be reproduced in routinely immunised women. Continued monitoring of attendance for the first smear and subsequent routine smears is needed.
authors.affiliation: Department of Pathology, University of Edinburgh, EH16 4SA, University of Edinburgh, Edinburgh, Scotland.
authors.forename: T J
authors.initials: TJ
authors.lastname: Palmer
authors.affiliation: Information Services Division, NHS National Services Scotland, Gyle Square, Edinburgh EH12 9EB, UK.
authors.forename: M
authors.initials: M
authors.lastname: McFadden
authors.affiliation: Health Protection Scotland, Glasgow G2 6QE, Scotland.
authors.forename: K G J
authors.initials: KG
authors.lastname: Pollock
authors.affiliation: Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, Scotland.
authors.forename: K
authors.initials: K
authors.lastname: Kavanagh
authors.affiliation: Scottish Human Papillomavirus Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, Scotland.
authors.forename: K
authors.initials: K
authors.lastname: Cuschieri
authors.affiliation: Department of Gynaecology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZD, Scotland.
authors.forename: M
authors.initials: M
authors.lastname: Cruickshank
authors.affiliation: Department of Cytology, Ninewells Hospital, Dundee DD1 9SY, Scotland.
authors.forename: S
authors.initials: S
authors.lastname: Nicoll
authors.affiliation: Health Protection Scotland, Glasgow G2 6QE, Scotland.|Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, Scotland.|International Prevention Research Institute, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Robertson
mesh_terms: D016022:Case-Control Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D012189:Retrospective Studies; D012606:Scotland; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines