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New data reveal that routine vaccination against HPV in Scotland has led to a dramatic fall in cervical disease that can lead to cancer.
The vaccine protects against the human papillomavirus (HPV), which is responsible for most strains of cervical cancer. In 2008, routine vaccination of 12- and 13-year-old girls against HPV was introduced in schools in the United Kingdom. Vaccination has significantly reduced the number of HPV infections, but there has not been much published evidence of the impact this has had on cervical disease and cancer .
A new study published in the British Medical Journal revealed a dramatic drop in the proportion of 20-year-old vaccinated women screened for cervical disease screening – abnormal cells and cancer precursors.
The researchers found an 89% drop in the number of patients with the most severe disease levels, called cervical intraepithelial neoplasia or CIN. There are three degrees of CIN, the most severe giving the highest cancer risk, CIN3 +.
There was a 88% reduction in grade CIN 2 or worse and 79% in grade CIN 1.
There was a greater decrease in illness among those vaccinated at age 12 or 13 (89%) than among those vaccinated at age 17 (51%). The vaccine is known to be more effective in those who have not yet encountered HPV, which is a badually transmitted infection.
But there was also a decline in disease levels among unvaccinated women, suggesting an effect of "collective immunity," say the authors – because there are fewer HPV viruses in the community .
Routine screening for cervical cancer remains highly recommended for women, even if they have been vaccinated, but this could change, according to the authors.
"Low rates of cervical cancer after routine immunization clearly have implications for screening vaccinated women," the study says.
"Although the number of major diseases has decreased in Scotland, it has not been eradicated and therefore continuous screening is needed, especially since, for several years, most of the women participating in the screening program have not been tested. 39 will not have been vaccinated. "
But in the long run, it may be that "two or three screens during a lifetime using the HPV test are sufficient," says the newspaper. "Ultimately, the clinical and economic reasons for cervical screening will need to be examined."
Julia Brotherton, Medical Director of the Australian National Registry of the VCS Foundation's HPV Immunization Program, said in an editorial published in the journal that the results are "spectacular and document a dramatic reduction in the number of high-grade cervical diseases with the weather". HPV vaccination in countries where it is not yet available or accepted.
"We need to work for a world in which all girls and their families are offered HPV vaccination wherever and wherever they live. We must also actively develop, mobilize and develop more effective, feasible and culturally acceptable strategies for cervical cancer screening, such as automatic specimen collection, if we are to ever effectively reduce the global burden of cervical cancer " .
Robert Music, Executive Director of Jo's Cervical Cancer Trust, said, "The results of this research are extremely interesting and clearly demonstrate the impact of the HPV vaccine on the protection of cervical health for future generations. We are fortunate to have such an effective prevention program, which means that the elimination of cervical cancer is firmly under consideration. Focusing on communities and areas where the rate of use is below the national average should be a priority. "
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