Adherence to cervical screening in the era of human papillomavirus vaccination: how low is too low?

The Lancet Infectious Diseases
Chris BauchAlison P Galvani

Abstract

Human papillomavirus vaccine prevents infection by two major oncogenic types of the virus. Continued screening is needed in vaccinated women to prevent cancers caused by high-risk types not included in the vaccine. An exaggerated sense of protection from the vaccine could lead to a decline in the rate of screening among vaccinated women, which in principle could lead to an increase in the incidence of cervical cancer. We present a simple mathematical model of vaccination, screening, and disease incidence, including an analysis of the effect of data uncertainties. For a population with opportunistic screening and 30% vaccine coverage, screening rates in vaccinated women would have to decline by at least 80% (median value of probabilistic uncertainty analysis) before the incidence of cervical cancer would increase in the era since the introduction of the vaccine. By comparison, the decline needed is at least 49% in a population with organised screening and 70% vaccine coverage. In populations that have highly effective cervical screening programmes, incidence of cervical cancer starts to increase after smaller, but still substantial, decreases in screening. Introduction of vaccine is unlikely to lead to an increased incidence of ...Continue Reading

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Citations

Aug 28, 2010·The Lancet Infectious Diseases·Diane M HarperMatti Lehtinen
Sep 17, 2011·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Seema YasminSally Blower
Aug 10, 2010·JAAPA : Official Journal of the American Academy of Physician Assistants·Michelle Lynn Heinan, UNKNOWN Clinical and Scientific Affairs Council of the AAPA
Dec 15, 2010·Future Oncology·Johannes Berkhof, Johannes A Bogaards
Nov 26, 2010·Obstetrics and Gynecology·Amy H WallaceEvan R Myers
Apr 6, 2011·Molecular Carcinogenesis·Jae Hong NoYong-Sang Song
Jun 13, 2012·International Journal of Cancer. Journal International Du Cancer·Anneke SteensHester E de Melker
Jun 2, 2011·International Journal of Cancer. Journal International Du Cancer·Everardo Hernandez-PlataJuan C Gomora
Apr 22, 2016·Cancer Epidemiology·Stephanie D BooneDiane M Harper
Sep 21, 2010·Medicine, Health Care, and Philosophy·Erik MalmqvistMatti Lehtinen

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