Dataset Information

Opportunistic HPV vaccination at age 16-23 and cervical screening attendance in Sweden: a national register-based cohort study.

ABSTRACT: OBJECTIVES:To investigate whether cervical screening attendance differs between human papillomavirus (HPV)-vaccinated and unvaccinated women and to investigate potential underlying socioeconomic factors. DESIGN:Prospective cohort using registry linkage of vaccinations, screening invitations, screening attendance and socioeconomic covariates. SETTING:Swedish national HPV vaccination and cervical screening programmes. PARTICIPANTS:All Swedish women born between 1988 and 1991 and invited to screening (n=261?434). OUTCOME MEASURES:All participants were followed for up to 3?years. Screening attendance was compared between HPV-vaccinated and unvaccinated women. HR and 95% CI were estimated using Cox regression. RESULTS:Vaccination age averaged 18.1?years and the coverage for?1?dose was 13.5%. In HPV-vaccinated women (n=35?460), screening attendance was higher than in unvaccinated women (n=225?974) (74%vs69%, p<0.001). The crude HR of attendance in HPV-vaccinated women was 1.32 (95% CI 1.30 to 1.34). A positive association remained after adjustment for education, income and migration history (HR=1.10, 95%?CI 1.09 to 1.12). CONCLUSION:HPV-vaccinated women were more likely to attend screening than unvaccinated women. Yet, the question needs to be reassessed in routinely vaccinated cohorts, since the vaccinated women included here represent a selected group and may be prone to more health-conscious habits.

SUBMITTER: Kreusch T

PROVIDER: S-EPMC6169773 | biostudies-other | 2018 Oct

REPOSITORIES: biostudies-other

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Opportunistic HPV vaccination at age 16-23 and cervical screening attendance in Sweden: a national register-based cohort study.

Kreusch Teresa T Wang Jiangrong J Sparén Pär P Sundström Karin K

BMJ open 20181002 10

<h4>Objectives</h4>To investigate whether cervical screening attendance differs between human papillomavirus (HPV)-vaccinated and unvaccinated women and to investigate potential underlying socioeconomic factors.<h4>Design</h4>Prospective cohort using registry linkage of vaccinations, screening invitations, screening attendance and socioeconomic covariates.<h4>Setting</h4>Swedish national HPV vaccination and cervical screening programmes.<h4>Participants</h4>All Swedish women born between 1988 an ...[more]

PMID: 30282687

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Project description:Background While HPV vaccination uptake in Sweden is quite high, at around 80%, vaccine hesitancy remains an issue in countries throughout Europe. The latter can be related to a contemporary context of increased contestation of expert knowledge and of a large share of information on health-related issues including vaccination today being sought via the internet. Still, there is a paucity of recent research on attitudes toward the HPV vaccine in a larger sample of the population in Sweden. This survey study assesses such attitudes and any correlations between vaccine hesitancy and sociodemographic characteristics, trust in healthcare and other societal institutions, and evaluation of the reliability of different sources of information. Methods The validated survey questionnaire was distributed to adult women in Sweden (n = 2,000), via a nationally representative web panel. The response rate was 37%. Aside from descriptive statistics, associations between vaccine hesitancy and sociodemographic and other variables were computed using logistic regressions and expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). Results Our results show a positive attitude toward HPV vaccination overall. Still, some degree of HPV vaccine hesitancy was indicated by 33.8% of the respondents, and more pronounced hesitancy by 7.6%. Regarding vaccination in general, a very positive attitude was indicated by 55%. HPV vaccine hesitancy was associated with low education and low income and strongly associated with a lack of confidence in healthcare and other societal institutions. It was also correlated with a self-assessed lack of access to, and ability to assess the origin, quality and reliability of, information about the HPV vaccine. Conclusion Efforts to provide transparent information about HPV vaccination should be combined with healthcare providers being open to discuss vaccine concerns with patients and avoiding practices that do not promote trust.

Project description:BackgroundCandidate human papillomavirus (HPV) vaccines have demonstrated almost 90%-100% efficacy in preventing persistent, type-specific HPV infection over 18 mo in clinical trials. If these vaccines go on to demonstrate prevention of precancerous lesions in phase III clinical trials, they will be licensed for public use in the near future. How these vaccines will be used in countries with national cervical cancer screening programmes is an important question.Methods and findingsWe developed a transmission model of HPV 16 infection and progression to cervical cancer and calibrated it to Finnish HPV 16 seroprevalence over time. The model was used to estimate the transmission probability of the virus, to look at the effect of changes in patterns of sexual behaviour and smoking on age-specific trends in cancer incidence, and to explore the impact of HPV 16 vaccination. We estimated a high per-partnership transmission probability of HPV 16, of 0.6. The modelling analyses showed that changes in sexual behaviour and smoking accounted, in part, for the increase seen in cervical cancer incidence in 35- to 39-y-old women from 1990 to 1999. At both low (10% in opportunistic immunisation) and high (90% in a national immunisation programme) coverage of the adolescent population, vaccinating women and men had little benefit over vaccinating women alone. We estimate that vaccinating 90% of young women before sexual debut has the potential to decrease HPV type-specific (e.g., type 16) cervical cancer incidence by 91%. If older women are more likely to have persistent infections and progress to cancer, then vaccination with a duration of protection of less than 15 y could result in an older susceptible cohort and no decrease in cancer incidence. While vaccination has the potential to significantly reduce type-specific cancer incidence, its combination with screening further improves cancer prevention.ConclusionsHPV vaccination has the potential to significantly decrease HPV type-specific cervical cancer incidence. High vaccine coverage of women alone, sustained over many decades, with a long duration of vaccine-conferred protection, would have the greatest impact on type-specific cancer incidence. This level of coverage could be achieved through national coordinated programmes, with surveillance to detect cancers caused by nonvaccine oncogenic HPV types.

Dataset Information

Opportunistic HPV vaccination at age 16-23 and cervical screening attendance in Sweden: a national register-based cohort study.

Publications

Opportunistic HPV vaccination at age 16-23 and cervical screening attendance in Sweden: a national register-based cohort study.

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