Cervical Cancer Screening HPV Strategies for Vaccinated Cohorts

HPV vaccination programmes have been implemented across Europe over the past two decades with the aim of reducing the burden of HPV-related cancers, of which cervical cancer is the most significant. To fully realise the benefits of HPV vaccination, cervical cancer screening programmes must be adapted to reflect the substantially lower risk of disease in vaccinated cohorts. Without such adaptation, the balance between the harms and benefits of screening may shift unfavourably, for example, by increasing the relative burden of follow-up examinations or unnecessary treatments.

Screening Strategies

Adapting screening strategies requires consideration not only of vaccinated women but also of those who remain unvaccinated. HPV vaccination reduces viral circulation at the population level, thereby lowering cervical cancer risk even among unvaccinated women. However, in situations where vaccination uptake is insufficient to significantly reduce circulation of vaccine-targeted HPV types, such as girls-only programmes with low coverage, the difference in cancer risk between vaccinated and unvaccinated individuals within the same birth cohorts is greatest. This presents challenges for implementing screening programmes in the absence of reliable information on individuals’ vaccination status. As vaccination programmes strengthen (expand to include boys and achieve higher coverage) these differences in risk are expected to diminish.

Modelling Approaches

In Task 10.1, we apply modelling approaches to identify feasible cervical cancer screening strategies for both vaccinated and unvaccinated women within vaccinated cohorts, under varying levels of vaccination coverage and the resulting degrees of indirect protection among unvaccinated women.

Author

Simopekka Vänskä