Projected impact of HPV vaccination and primary HPV screening on cervical adenocarcinoma: Example from Australia

摘要

Cytology-based cervical screening appears to have had a limited effect on the incidence of adenocarcinoma, however HPV vaccination and HPV-based screening will likely play a role in reducing future burden. Using Australia as an example, we estimated the future burden (2015–2040) of adenocarcinoma in the absence of other interventions; and the impact of HPV vaccination (introduced 2007) and HPV-based screening (commencing 2017). Future burden was estimated considering underlying trends in adenocarcinoma, using national data (1982–2010). The relative reduction in adenocarcinoma due to HPV vaccination and HPV-based screening was derived from observed clinical data. Adenocarcinoma incidence rates have been increasing since the early-mid 2000s (average annual increases from 3.0%(25–49 years) ?8.1%(20–24 years)). If these trends continue, rates would increase from 1.4 to 2.4/100,000 in 50 years and from 2.2 to 4.4/100,000 in 50+ years by 2040. Taking into account coverage, HPV vaccination will reduce 2040 incidence by 36–39%, mainly in women 50 years (61% reduction). Taking into account uncertainties in trends and screening effectiveness, HPV-based screening will reduce incidence by an additional 19–43%, mainly in women 50+ years (additional 30–68% reduction). Together, these interventions will reduce incidence by 55–81%. Highlights ? Impact of HPV screening & vaccination on adenocarcinoma has not yet been estimated. ? Incidence rates will drop by 50% in Australia due to HPV screening & vaccination. ? Majority of impact in women aged 50 before 2040 is from HPV vaccination. ? In women aged 50+ virtually only impact before 2040 is from HPV screening. ? Screening impact in women 50+ is comparable to vaccination impact in women 50.