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Translation of a-t 2020; 51: 80


HPV vaccination - initial data on the risk of cervical cancer

Several randomised studies have shown that vaccination against human papillomavirus (HPV; CERVARIX, GARDASIL 9) reduces the rate of higher grade dysplasia of the cervix, and this has been confirmed in numerous cohort and case control studies (e.g. a-t 2019; 50: 68-70). Evidence of the hoped-for impact of immunisation on cervical cancer, however, had yet to be obtained. A Swedish register study (1) that was recently published looks for the first time at the effect of HPV vaccination on the risk of cervical cancer: more than 1.6 million girls and women who were aged between 10 and 30 in the period from 2006 to 2017 were included. Around a third had received at least one dose of the quadrivalent HPV vaccine GARDASIL (no longer on the market)*, which was available in Sweden from late 2006 and offered free of charge from 2012 onwards to girls aged 10 to 18 as part of school and catch-up vaccination programmes (prior to this, immunisation was recommended for girls aged between 13 and 17 with only some of the costs covered). Screening for cervical cancer is carried out in women between the ages of 23 and 64 in Sweden, with invitations every three to seven years depending on the woman's age. During the study period, an invasive carcinoma of the cervix was diagnosed in 19 vaccinated and 538 non-vaccinated women, corresponding to incidences of 0.73 and 5.27 per 100,000 women years respectively. After adjusting for age, various socioeconomic factors and other things, a risk reduction of around 60% was calculated (Incidence Rate Ratio [IRR] 0.37; 95% confidence interval [CI] 0.21-0.57). As expected, the benefit was greater for women who were younger at the point at which they were immunised: if the vaccination is administered before a woman's 17th birthday, the risk of cervical cancer drops by 88% (2 cases; IRR 0.12; 95% CI 0.00-0.34) while the risk among those who are immunised later "only" drops by 53% (17 cases; IRR 0.47; 95% CI 0.27-0.75). If the data are analysed with regard to vaccination before or after a woman's 20th birthday, the calculated risk reduction is similar (IRR 0.36 and IRR 0.38 respectively) (1). Observational studies are fundamentally subject to the risk of bias, which cannot be entirely balanced out by making adjustments. However, we believe that the size of the effect and the biological plausibility indicate that the HPV vaccination does indeed protect against cervical cancer, -Ed.

!LEI, J. et al.: N. Engl. J. Med. 2020; 383: 1340-8
* in the meantime replaced by GARDASIL 9 which covers five more oncogen HIV types

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