The impact of catch-up bivalent human papillomavirus vaccination on cervical screening outcomes: an observational study from the English HPV primary screening pilot

Matejka Rebolj; Francesca Pesola; Christopher Mathews; David Mesher; Kate Soldan; Henry Kitchener

doi:10.1038/s41416-022-01791-w

The impact of catch-up bivalent human papillomavirus vaccination on cervical screening outcomes: an observational study from the English HPV primary screening pilot

Matejka Rebolj^*, Francesca Pesola, Christopher Mathews, David Mesher, Kate Soldan, Henry Kitchener

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: In England, bivalent vaccination (Cervarix) against high-risk human papillomavirus (HR-HPV) genotypes 16/18 was offered in a population-based catch-up campaign in 2008–2010 to girls aged 14–17 years. These women are now entering the national cervical screening programme. We determined the impact of catch-up bivalent vaccination on their screening outcomes.

Methods: We studied the overall and genotype-specific screening outcomes in 108,138 women aged 24–25 (offered vaccination) and 26–29 years (not offered vaccination) included in the English HPV screening pilot between 2013 and 2018.

Results: At 24–25 years, the detection of high-grade cervical intraepithelial neoplasia (CIN2+) associated with HPV16/18 decreased from 3 to 1% (p < 0.001), with estimated vaccine effectiveness of 87% (95% CI: 82–91%). The detection of any CIN2+ halved from 6 to 3% (p < 0.001), with an estimated vaccine effectiveness of 72% (95% CI: 66–77%). The positive predictive value of a colposcopy for CIN2+ decreased for both low-grade (p < 0.001) and high-grade (p = 0.02) abnormalities on triage cytology. The decreases in screen-detected abnormalities at age 26-29 were of a substantially smaller magnitude.

Conclusions: These data confirm high effectiveness of bivalent HPV vaccination delivered through a population-based catch-up campaign in England. These findings add to the rationale for extending screening intervals for vaccinated cohorts.

Original language	English
Pages (from-to)	278-287
Number of pages	10
Journal	British Journal of Cancer
Volume	127
Issue number	2
DOIs	https://doi.org/10.1038/s41416-022-01791-w
Publication status	Published - 26 Mar 2022

Bibliographical note

Funding Information: The English HPV pilot was funded by Public Health England. Public Health England had a role in designing the pilot; in the collection of the data; and commented on the manuscript. MR was supported by Cancer Research UK (reference: C8162/A27047). CM was supported by Cancer Research UK (reference: C8162/A27047) and Public Health England (reference: ODR 1718_428). FP was supported by Cancer Research UK (reference: C8162/A25356). Cancer Research UK had no role in designing the study, in the collection of the data, and in the writing of the manuscript. The authors made the decision to submit.

MR: funding from Public Health England for the epidemiological evaluation of the HPV primary screening pilot; attended meetings with various HPV assay manufacturers; fee for lecture from Hologic paid to employer (2018); member of various groups convened by Public Health England providing advice to the English Cervical Screening Programme. CM: held an honorary appointment at Public Health England to process the data for the pilot. FP: declares no conflict of interest. DM and KS: The Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service has provided GSK with post-marketing surveillance reports on HPV infections; a cost recovery charge is made for these reports. HK: Former chair of the Advisory Committee for Cervical Screening (Public Health England), but the views expressed in this manuscript are those of the author and do not represent the view of Public Health England.

Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Publisher Copyright: © 2022, The Author(s).

Citation: Rebolj, M., Pesola, F., Mathews, C. et al. The impact of catch-up bivalent human papillomavirus vaccination on cervical screening outcomes: an observational study from the English HPV primary screening pilot. Br J Cancer (2022).

DOI: https://doi.org/10.1038/s41416-022-01791-w

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title = "The impact of catch-up bivalent human papillomavirus vaccination on cervical screening outcomes: an observational study from the English HPV primary screening pilot",

abstract = "Background: In England, bivalent vaccination (Cervarix) against high-risk human papillomavirus (HR-HPV) genotypes 16/18 was offered in a population-based catch-up campaign in 2008–2010 to girls aged 14–17 years. These women are now entering the national cervical screening programme. We determined the impact of catch-up bivalent vaccination on their screening outcomes. Methods: We studied the overall and genotype-specific screening outcomes in 108,138 women aged 24–25 (offered vaccination) and 26–29 years (not offered vaccination) included in the English HPV screening pilot between 2013 and 2018. Results: At 24–25 years, the detection of high-grade cervical intraepithelial neoplasia (CIN2+) associated with HPV16/18 decreased from 3 to 1% (p < 0.001), with estimated vaccine effectiveness of 87% (95% CI: 82–91%). The detection of any CIN2+ halved from 6 to 3% (p < 0.001), with an estimated vaccine effectiveness of 72% (95% CI: 66–77%). The positive predictive value of a colposcopy for CIN2+ decreased for both low-grade (p < 0.001) and high-grade (p = 0.02) abnormalities on triage cytology. The decreases in screen-detected abnormalities at age 26-29 were of a substantially smaller magnitude. Conclusions: These data confirm high effectiveness of bivalent HPV vaccination delivered through a population-based catch-up campaign in England. These findings add to the rationale for extending screening intervals for vaccinated cohorts.",

author = "Matejka Rebolj and Francesca Pesola and Christopher Mathews and David Mesher and Kate Soldan and Henry Kitchener",

note = "Funding Information: The English HPV pilot was funded by Public Health England. Public Health England had a role in designing the pilot; in the collection of the data; and commented on the manuscript. MR was supported by Cancer Research UK (reference: C8162/A27047). CM was supported by Cancer Research UK (reference: C8162/A27047) and Public Health England (reference: ODR 1718_428). FP was supported by Cancer Research UK (reference: C8162/A25356). Cancer Research UK had no role in designing the study, in the collection of the data, and in the writing of the manuscript. The authors made the decision to submit. MR: funding from Public Health England for the epidemiological evaluation of the HPV primary screening pilot; attended meetings with various HPV assay manufacturers; fee for lecture from Hologic paid to employer (2018); member of various groups convened by Public Health England providing advice to the English Cervical Screening Programme. CM: held an honorary appointment at Public Health England to process the data for the pilot. FP: declares no conflict of interest. DM and KS: The Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service has provided GSK with post-marketing surveillance reports on HPV infections; a cost recovery charge is made for these reports. HK: Former chair of the Advisory Committee for Cervical Screening (Public Health England), but the views expressed in this manuscript are those of the author and do not represent the view of Public Health England. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article{\textquoteright}s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article{\textquoteright}s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. Publisher Copyright: {\textcopyright} 2022, The Author(s). Citation: Rebolj, M., Pesola, F., Mathews, C. et al. The impact of catch-up bivalent human papillomavirus vaccination on cervical screening outcomes: an observational study from the English HPV primary screening pilot. Br J Cancer (2022). DOI: https://doi.org/10.1038/s41416-022-01791-w",

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The impact of catch-up bivalent human papillomavirus vaccination on cervical screening outcomes: an observational study from the English HPV primary screening pilot. / Rebolj, Matejka; Pesola, Francesca; Mathews, Christopher et al.
In: British Journal of Cancer, Vol. 127, No. 2, 26.03.2022, p. 278-287.

Research output: Contribution to journal › Article › peer-review

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T1 - The impact of catch-up bivalent human papillomavirus vaccination on cervical screening outcomes

T2 - an observational study from the English HPV primary screening pilot

AU - Rebolj, Matejka

AU - Pesola, Francesca

AU - Mathews, Christopher

AU - Mesher, David

AU - Soldan, Kate

AU - Kitchener, Henry

N1 - Funding Information: The English HPV pilot was funded by Public Health England. Public Health England had a role in designing the pilot; in the collection of the data; and commented on the manuscript. MR was supported by Cancer Research UK (reference: C8162/A27047). CM was supported by Cancer Research UK (reference: C8162/A27047) and Public Health England (reference: ODR 1718_428). FP was supported by Cancer Research UK (reference: C8162/A25356). Cancer Research UK had no role in designing the study, in the collection of the data, and in the writing of the manuscript. The authors made the decision to submit. MR: funding from Public Health England for the epidemiological evaluation of the HPV primary screening pilot; attended meetings with various HPV assay manufacturers; fee for lecture from Hologic paid to employer (2018); member of various groups convened by Public Health England providing advice to the English Cervical Screening Programme. CM: held an honorary appointment at Public Health England to process the data for the pilot. FP: declares no conflict of interest. DM and KS: The Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service has provided GSK with post-marketing surveillance reports on HPV infections; a cost recovery charge is made for these reports. HK: Former chair of the Advisory Committee for Cervical Screening (Public Health England), but the views expressed in this manuscript are those of the author and do not represent the view of Public Health England. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. Publisher Copyright: © 2022, The Author(s). Citation: Rebolj, M., Pesola, F., Mathews, C. et al. The impact of catch-up bivalent human papillomavirus vaccination on cervical screening outcomes: an observational study from the English HPV primary screening pilot. Br J Cancer (2022). DOI: https://doi.org/10.1038/s41416-022-01791-w

PY - 2022/3/26

Y1 - 2022/3/26

N2 - Background: In England, bivalent vaccination (Cervarix) against high-risk human papillomavirus (HR-HPV) genotypes 16/18 was offered in a population-based catch-up campaign in 2008–2010 to girls aged 14–17 years. These women are now entering the national cervical screening programme. We determined the impact of catch-up bivalent vaccination on their screening outcomes. Methods: We studied the overall and genotype-specific screening outcomes in 108,138 women aged 24–25 (offered vaccination) and 26–29 years (not offered vaccination) included in the English HPV screening pilot between 2013 and 2018. Results: At 24–25 years, the detection of high-grade cervical intraepithelial neoplasia (CIN2+) associated with HPV16/18 decreased from 3 to 1% (p < 0.001), with estimated vaccine effectiveness of 87% (95% CI: 82–91%). The detection of any CIN2+ halved from 6 to 3% (p < 0.001), with an estimated vaccine effectiveness of 72% (95% CI: 66–77%). The positive predictive value of a colposcopy for CIN2+ decreased for both low-grade (p < 0.001) and high-grade (p = 0.02) abnormalities on triage cytology. The decreases in screen-detected abnormalities at age 26-29 were of a substantially smaller magnitude. Conclusions: These data confirm high effectiveness of bivalent HPV vaccination delivered through a population-based catch-up campaign in England. These findings add to the rationale for extending screening intervals for vaccinated cohorts.

AB - Background: In England, bivalent vaccination (Cervarix) against high-risk human papillomavirus (HR-HPV) genotypes 16/18 was offered in a population-based catch-up campaign in 2008–2010 to girls aged 14–17 years. These women are now entering the national cervical screening programme. We determined the impact of catch-up bivalent vaccination on their screening outcomes. Methods: We studied the overall and genotype-specific screening outcomes in 108,138 women aged 24–25 (offered vaccination) and 26–29 years (not offered vaccination) included in the English HPV screening pilot between 2013 and 2018. Results: At 24–25 years, the detection of high-grade cervical intraepithelial neoplasia (CIN2+) associated with HPV16/18 decreased from 3 to 1% (p < 0.001), with estimated vaccine effectiveness of 87% (95% CI: 82–91%). The detection of any CIN2+ halved from 6 to 3% (p < 0.001), with an estimated vaccine effectiveness of 72% (95% CI: 66–77%). The positive predictive value of a colposcopy for CIN2+ decreased for both low-grade (p < 0.001) and high-grade (p = 0.02) abnormalities on triage cytology. The decreases in screen-detected abnormalities at age 26-29 were of a substantially smaller magnitude. Conclusions: These data confirm high effectiveness of bivalent HPV vaccination delivered through a population-based catch-up campaign in England. These findings add to the rationale for extending screening intervals for vaccinated cohorts.

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The impact of catch-up bivalent human papillomavirus vaccination on cervical screening outcomes: an observational study from the English HPV primary screening pilot

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