Association between HPV vaccination and cervical screening policy changes and cervical cancer incidence and grade-3 cervical intraepithelial neoplasia incidence in England, 2006–2020: a population-based trends analysis

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2025-02-01 DOI:10.1016/j.lanepe.2024.101157

Milena Falcaro , Alejandra Castañón , Busani Ndlela , Peter Sasieni

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引用次数: 0

Abstract

Background

Monitoring trends in diseases after the implementation of new public health interventions or policy changes is crucial for public health planning and surveillance. In this study we look at variations in rates of cervical cancer and grade-3 cervical intraepithelial neoplasia (CIN3) incidence between 2006 and 2020 in England and relate them to predictions based on the changes in HPV vaccination and cervical screening policy.

Methods

Using population-based registry data, we estimated incidence rates and their 95% confidence intervals for cervical cancer and CIN3 by age group and by either year of diagnosis or 1-year birth cohort. Trends were compared over time and across birth cohorts by calculating relative changes with respect to reference time points. We also tested if trends in women offered HPV vaccination were significantly different across outcomes (cervical cancer and CIN3) and age groups. To do this, we used Poisson regression with adjustments for interval censoring, overdispersion and correlation between observations.

Findings

There were 5558 cancers and 164,682 cases of CIN3 from 53.4 million women-years of observation in the age group 20–29.99 years. We found no evidence of increased cervical cancer rates over the age of 26 in cohorts not offered cervical screening until age 24.5 or 25 years. Substantial and increasing reductions in CIN3s and cervical cancers were observed in the cohorts offered HPV vaccination and were consistent with an 80% (95% CI: 72.9%–87.1%) decrease in cervical neoplasia in the routine vaccination group.

Interpretation

Plots against different time scales (e.g., calendar year and date of birth) may provide important insights that could otherwise be missed. Our findings are consistent with a sustained high effectiveness of the HPV immunization programme as the catch-up vaccination cohorts age.

Funding

Cancer Research UK.

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2006-2020年英国HPV疫苗接种和宫颈筛查政策变化与宫颈癌发病率和三级宫颈上皮内瘤变发病率之间的关系：基于人群的趋势分析

背景：监测实施新的公共卫生干预措施或政策变化后的疾病趋势对公共卫生规划和监测至关重要。在这项研究中，我们观察了2006年至2020年间英国宫颈癌和三级宫颈上皮内瘤变（CIN3）发病率的变化，并将其与基于HPV疫苗接种和宫颈筛查政策变化的预测联系起来。方法：使用基于人群的登记数据，我们按年龄组、诊断年份或1年出生队列估计宫颈癌和CIN3的发病率及其95%置信区间。通过计算相对于参考时间点的相对变化来比较不同时间和不同出生队列的趋势。我们还测试了接种HPV疫苗的妇女在结局（宫颈癌和CIN3）和年龄组之间的趋势是否有显著差异。为了做到这一点，我们使用了泊松回归，并对观测值之间的间隔审查、过度分散和相关性进行了调整。结果：在20-29.99岁年龄组的5340万女性中，观察到5558例癌症和164,682例CIN3。我们没有发现26岁以上人群中直到24.5岁或25岁才接受子宫颈筛查的人群宫颈癌发病率增加的证据。在提供HPV疫苗接种的队列中，观察到cin3和宫颈癌的显著减少和增加，并且与常规疫苗接种组宫颈瘤变减少80% （95% CI: 72.9%-87.1%）一致。解释：不同时间尺度（例如，日历年和出生日期）的图可能会提供重要的见解，否则可能会被遗漏。我们的研究结果与HPV免疫接种计划随着追赶疫苗接种队列年龄的增长而持续的高有效性相一致。资助：英国癌症研究中心。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.