Performance of cervical screening a decade following HPV vaccination: The Costa Rica Vaccine Trial
Menée au Costa Rica auprès de 4 632 femmes âgées de 25 à 36 ans (durée médiane de suivi : 4,3 ans), cette étude évalue, en fonction de leur statut vaccinal contre le papillomavirus humain, la performance de plusieurs modalités de dépistage du cancer du col de l'utérus pour détecter des lésions précancéreuses de haut grade
We investigated the impact of HPV vaccination on the performance of cytology-based and HPV-based screening for detection of cervical precancer among women vaccinated as young adults and reaching screening age.A total of 4632 women aged 25–36 years from the Costa Rica HPV Vaccine Trial were included (2418 HPV-vaccinated as young adults and 2214 unvaccinated). We assessed the performance of cytology- and HPV-based cervical screening modalities in vaccinated and unvaccinated women to detect high-grade cervical precancers diagnosed over four years, and the absolute risk of cumulative cervical precancers by screening results at entry.We detected 95 CIN3 + (52 in unvaccinated and 43 in vaccinated women). HPV16/18/31/33/45 was predominant (69%) among unvaccinated participants, and HPV35/52/58/39/51/56/59/66/68 predominated (65%) among vaccinated participants. Sensitivity and specificity of cervical screening approaches were comparable between women vaccinated as young adults and unvaccinated women. Colposcopy referral rates were lower in the vaccinated group for HPV-based screening modalities, but the positive predictive value (PPV) was comparable between the two groups.Among women approaching screening ages, vaccinated as young adults and with a history of intensive screening, the expected reduction in the PPV of HPV testing, associated with dropping prevalence of HPV-associated lesions, was not observed. This is likely due to the presence of high-grade lesions associated with non-vaccine HPV types, which may be less likely to progress to cancer.
Journal of the National Cancer Institute , article en libre accès, 2021