Human papillomavirus vaccine, especially before age 17, is associated with a large reduction in invasive cervical cancer

Référence

Lei J, Ploner A, Elfstrom KM, et al. HPV vaccination and the risk of invasive cervical cancer. N Engl J Med 2020;383(14):1340-1348.

Sommaire

There are limited data to date regarding whether HPV vaccination actually prevents invasive cervical cancer. This Swedish study used data from a national health registry of more than 1.6 million girls and women who were between the ages of 10 and 30 years between 2006 and 2017. In Sweden, HPV vaccination was offered for girls aged 13 to 17 years starting in 2007, with expansion to younger and older girls in 2012. Cervical cancer screening in Sweden begins at age 23 and is performed at intervals of 3 years to 7 years, depending on age. A quadrivalent vaccine (types 6, 11, 16 and 18) was used. The researchers reviewed registries with information about cancer diagnoses and vaccination. A total of 1,145,112 patients did not receive an HPV vaccine, while 527,871 received at least one dose during the study period. At baseline, girls who were vaccinated were more likely to have a Swedish-born mother and come from a high-income family. The primary outcome was the IRR for invasive cervical cancer between vaccinated and unvaccinated girls and women, adjusted for age, calendar year of immunization, and parental and residential characteristics. The crude incidence rates were 5.3 per 100,000 person-years for unvaccinated participants and 0.73 per 100,000 person-years for those who had been vaccinated. The fully adjusted IRR was 0.37 (0.21 - 0.57) for invasive cervical cancer. For girls vaccinated before age 17 years, the IRR was 0.12 (0.00 - 0.34), while for those vaccinated between the ages of 17 and 30 years it was 0.47 (0.27 - 0.75).