NEJM: HPV vaccination and risk of cervical cancer

BACKGROUND Studies have shown that the four-price HPV vaccine can effectively prevent cervical high-level endoculocular lesions, but the relationship between the four-price HPV vaccine and the risk of infested cervical cancer has not been fully demonstrated.
Methods The following follow-up to the Swedish National Population and Health Register surveyed 1672,983 women aged 10 to 30 between 2006 and 2017 to assess the relationship between HPV vaccination and risk of insulated cervical cancer, and to intervene in controlling factors such as age, age, place of residence, parental characteristics (including education, family income, mother's country of birth, and history of disease).
results were 19 women vaccinated against tyrux HPV and 538 unvaccinated women were diagnosed with cervical cancer, with a cumulative incidence of cervical cancer 47/105 among vaccinated women and 94/10 among the unvaccinated population 5, after adjusting the age of follow-up, the incidence of cervical cancer in the vaccinated group compared to the unvaccinated group was 0.51 (95% CI 0.32-0.82), and other covarial variables were adjusted to occur The rate was 0.37 (95% CI 0.21-0.57), and after correcting all covariables, the incidence rate of those vaccinated before the age of 17 was 0.12 (12) 95% CI 0.00-0.34), 0.47 (95% CI 0.27-0.75) for those vaccinated between the ages of 17 and 30.
that the four-price HPV vaccine can significantly reduce the risk of leaching cervical cancer in the population.
the fundamental goal of HPV vaccination is to prevent the occurrence of leaching cervical cancer by preventing high-risk HPV infection1.
as of December 2019, a total of 124 countries and territories had included HPV vaccination in their national immunization plans2, while hpV tesp vaccination in Sweden had started in March 2006.
numerous studies in the past, including efficacy assessment 4-6 or effectiveness evaluation 7-13, have shown that HPV vaccines prevent HPV infections, genital warts, and cervical high-level endital lesions, and that vaccination can also prevent HPV-related Cancer, and not only limited to cervical cancer 14, but because of the longer study cycle (from HPV infection to clinically diagnosed cervical cancer), the risk of cervical lesions after vaccination decreased, randomized controlled trials in the past difficult to assess the effectiveness of the vaccine for the risk of cervical cancer.
study aims to study the relationship between HPV vaccination and cervical leaching cancer risk through Swedish national registration data.
study group Sweden has been subsidizing HPV vaccination for girls aged 13 to 17 since May 2007, implementing a free HPV vaccination policy for girls aged 13 to 18 in 2012, developing a school vaccination plan for girls aged 10 to 123, providing basic cervical cancer screening for women aged 23 to 64, and reviewing 155 per 3-7 years according to age notification.
This study was conducted through a survey of the Swedish population register between 2006 and 2017, targeting 16 women between the ages of 10 and 30, including women who had not been vaccinated against HPV in the past, non-immersive cervical cancer, non-immigrant women, and followed up with all eligible women until diagnosis, emigration, death, registration loss, and HPV secondary vaccination.
was approved by the Stockholm Regional Ethics Review Board and did not require the informed consent of the group.
data collection study used the Swedish National Population Register 17, HPV Vaccination Register 18, Prescription Drug Registry 19, National Vaccination Register 20, by retrieving HPV vaccination records to determine whether to vaccinate against HPV ty price vaccine 18.
Between 2007 and 2012, the government's four-price HPV vaccination subsidy program was identified using the J07BM01 code in the registry, and the National Vaccination Registry 20 began in 2013, covering almost all school HPV vaccination programs, the use code C53 for leaching cervical cancer, and the date of diagnosis is detailed in the Swedish Cancer Register.
The biological and adoptive parents of the participants are identified through the household registration form (which contains family contact information for the population born in Sweden after 1932),22 and the vertically integrated database is used for the study of parental characteristics, including the country of birth of the mother, the highest level of education of the parents, annual household income, the history of the mother's CIN3 plus disease, and the history of cancer other than cervical cancer.
a three-dose vaccination program with the HPV vaccination four-dose HPV vaccine, which has been in place in schools since 2015 and is classified as unvaccinated if not vaccinated during the study period.
the vaccination age was divided into two groups of vaccination before the age of 17 and vaccination before the age of 20 to assess the effectiveness of vaccination 10-13.
Sensitivity Analysis included HPV vaccination and birth cohorts in the study to test for group effects, and in order to eliminate the possibility of cervical cancer during HPV vaccination, the buffer period set 1 to 5 years after vaccination (Figures S4 and S5) was used through multiple interpolation to address missing covariable data.
Statistical analysis before the analysis, the statistical efficacy of cervical cancer incidence was evaluated, the medium efficacy was set at 0.94 (0.43 to 1.00), the corresponding vaccine coverage rate was 30%, the presumed risk of the vaccinated population was reduced by 70%, and the incidence of cervical cancer in the unvaccinated population was 4/105 per year.
In accordance with HPV vaccination, the cumulative incidence of cervical cancer was plotted according to the age of follow-up, the proportion of incidence was estimated using the Poisson regression model, the incidence of cervical cancer in vaccinated and unvaccinated women was compared, SAS 9.4 was used for efficacy comparison, and Stata 15.0 and R 3.6.3 were used for all other statistical analyses.
results of the study included 1672,983 women aged 10 to 30, of whom 527,871 women were vaccinated against HPV at least one dose, of which 438,939 (83.2%) were vaccinated before the age of 17, 538 unvaccinated women were diagnosed with cervical cancer, and 19 were diagnosed with vaccination.
HPV vaccination and cervical cancer in Sweden, whether or not HPV vaccine, the cumulative incidence of cervical cancer increased rapidly after the age of 23, the recommended age for screening for cervical cancer in the Forbidden City was 23 years old, and the cumulative incidence of cervical cancer in the unvaccinated group at age 30 rose sharply to 94 /105, the vaccination group was 47/105, the 17-30 age group was 54/105 people, and the cumulative incidence of cervical cancer at the age of 17 was only 4/105.
after adjusting the age of follow-up, the incidence rate of inoculation group and unvaccinated group was 0.51 (95% CI 0.32-0.82); 0.37 (95% CI 0.21-0.57); 12 (95% CI 0.00-0.34)vs 0.47 (95% CI 0.27-0.75), fully corrected incidence rate compared to pre-20-year-old vaccination group 0.36 (95% CI 0.18-0.61) and 0.38 (95% CI0.12-0.72) in the 20-30 age group.
sensitivity This study did not find a link between birth cohorts and the risk of cervical cancer associated with HPV vaccination.
With the introduction of the buffer period, the risk of cervical cancer in the HPV vaccine group was always lower than that in the unvaccinated group, 8 cases of cervical cancer were diagnosed in the vaccination group and 549 cases in the unvaccinated group.
discussion in this population-based cohort study, the results showed that four-price HPV vaccination significantly reduced the risk of leaching cervical cancer, according to the age of vaccination layered analysis, the incidence of immersive cervical cancer in the younger age group decreased more significantly.
Previous studies have confirmed the efficacy of HPV vaccine for HPV infection, genital warts, and cervical high-level endoculsive lesions (CIN2 plus and CIN3 plus) 4-6 and 7-13, and this study extends the effectiveness of HPV vaccine, showing that HPV titration vaccine significantly reduces the risk of leaching cervical cancer, which is the ultimate goal of HPV vaccination, the lower the age of vaccination, the lower the risk of cervical cancer.
, consistent with previous studies, HPV vaccination reduced the risk of wart infections and cervical high-level endotulitis by 10-13.
study also supports the greatest benefit of getting the HPV tessal vaccine prior to HPV infection, but has no therapeutic effect on HPV infection that occurred prior to vaccination24,25.
A follow-up study from the Finnish Cancer Registry reported that no HPV-related cancers were detected in vaccinated women, 10 HPV-related cancers (including 8 cases of cervical cancer) occurred in unvaccinated women, and vaccine protection was 100% (95% CI 16-100)14;
conclusions of this study are the same as those of the above study.
Women vaccinated before the age of 17 had an 88 per cent (66-100 per cent) lower risk of cervical cancer than those who were not vaccinated, and about 70 per cent of cervical cancers caused by HPV16 and type 18 worldwide were found to have a cross-protective effect on HPV16 or 18 infections in 84.4 per cent of women under the age of 30.
29 if HPV coverage in the population exceeds 50%, unvaccinated women will indirectly benefit.
7, studies have confirmed the group effect of HPV vaccination on genital warts in the Swedish population.
The study found that women born after 1993 had at least 50 per cent vaccination coverage, but sensitivity analysis did not observe group benefits in terms of cervical cancer risk, possibly due to the fact that it usually takes 5 to 20 years from HPV infection to cervical cancer, and that very few cases of inoculated cervical cancer occur in the associated birth queue during follow-up.
limitations of this study A small number of vaccinated women in this study were misclassified, but the potential greater concern was that there were other confounding factors in the relationship between HPV vaccination and the risk of cervical cancer, such as the fact that HPV vaccinators were generally healthier than the unvaccinated (i.e., healthy volunteer bias) and that several parental characteristics that might be associated with the potential risk of vaccination and cervical cancer were adjusted, however, lifestyle and health factors could not be excluded. (e.g. smoking, sexual activity, oral contraceptives, obesity, etc.), these factors are also associated with the risk of cervical cancer 32-34, cervical cancer is not only associated with HPV vaccination independently 35,36, but the level of parent education and family income adjustment also to some extent represents the influence of lifestyle factors 37, healthy volunteers bias in paid vaccination women may be more prominent.
In addition, cervical cancer screening rates were higher among women vaccinated against HPV, while the risk of CIN2 plus after HPV vaccination was significantly lower than in unvaccinated women, and treatment of pre-cancer lesions may underestimate the risk of cervical cancer 6,11,12.
the effects of vaccine doses cannot be inferred because of the low number of cases of cervical cancer observed by vaccinators.
: In this large-scale national study, women aged 10 to 30 were given a four-price HPV vaccine that significantly reduced the risk of infed cervical cancer.
Lei J, Ploner A, Elfström KM, et al. HPVVaccination and the Risk of Invasive Cervical Cancer. N Engl J Med.2020, 383 (14): 1340-8 Wang Xiaoxuan Li Aihua Source: Zhang Shi's former public number Copyright Notice: All text, pictures and audio and video materials on this website that indicate "Source: Mets Medicine" or "Source: MedSci Original" are owned by Mays Medical, and are not authorized, and any media, website or individual may not reproduce them with the authorization to indicate "Source: Mets Medicine".
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