Associations between prior HPV4 vaccine doses and cervical cancer screening participation.
Cervical cancer screening, regardless of HPV vaccination, is a cornerstone of cancer prevention. This study evaluated associations between prior HPV vaccine doses and initiation and continued participation of screening by age at vaccination.



Using electronic medical records for a safety net healthcare system (Truman Medical Center), women aged 14-26y vaccinated (n=1123) between 07/01/2006 and 10/1/2009 were randomly selected and matched on birth year and health campus to unvaccinated (n=1123) women. Frequency of screening was determined through 07/01/2013. Hazard ratios (HR) for screening were estimated using Cox proportional hazards regression.



Screening rates were higher after vaccination: unvaccinated (53%), first (62%), second (59%) or third (61%) doses. Women who initiated screening were less likely to complete the vaccine series, regardless of age. Women receiving one dose were more likely than unvaccinated women to initiate screening (HR=2.98 95% Confidence Interval (CI):2.45-3.61) and were more likely to screen than those receiving two (1 vs. 2, HR=2.94 95% CI:2.09-4.14) or three doses (1 vs. 3, HR=3.15 95% CI:2.21-4.48). Compared to unvaccinated women, women <21y who completed 3-doses were 1.8-times more likely to screen at ≥21y, whereas vaccinated women ≥21y were more likely to screen regardless of number of doses (p<0.0001).



Women who were vaccinated were more likely to screen than unvaccinated women; screening rate was highest after and occurred closest to the first vaccine dose. Research evaluating the efficacy of a one-dose vaccine is warranted and may provide both higher vaccination and screening rates.
University of Louisville, School of Public Health & Information Sciences, Department of Epidemiology & Population Health, James Graham Brown Cancer Center, Louisville, KY, USA. Electronic address: stephanie.boone@louisville.edu.
Stephanie D
SD
Boone
University of Louisville, School of Public Health & Information Sciences, Department of Bioinformatics and Biostatistics, Louisville, KY, USA.
Christina M
CM
Pinkston
University of Louisville, School of Public Health & Information Sciences, Department of Epidemiology & Population Health, James Graham Brown Cancer Center, Louisville, KY, USA.
Kathy B
KB
Baumgartner
University of Louisville, School of Public Health & Information Sciences, Department of Epidemiology & Population Health, James Graham Brown Cancer Center, Louisville, KY, USA.
Richard N
RN
Baumgartner
University of Louisville, Department of Mathematics, Louisville, KY, USA.
Sean M
SM
Harper
University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Aaron J
AJ
Bonham
University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Christopher A
CA
Paynter
University of Louisville, School of Medicine, Departments of Community and Geriatric Medicine, Obstetrics & Gynecology, Louisville, KY, USA; University of Louisville, School of Public Health and Information Sciences, Departments of Epidemiology & Population Health and Health Promotion & Behavioral Health Sciences, Louisville, KY, USA; University of Louisville, School of Engineering, Department of Bioengineering, Louisville, KY, USA.
Diane M
DM
Harper
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology; D014611:Vaccination / Q000379:methods*; D055815:Young Adult
D053918:Papillomavirus Vaccines
Cervarix; Cervical cancer screening; Compliance; Cox proportional hazards; Gardasil; HPV vaccine