Associations between prior HPV4 vaccine doses and cervical cancer screening participation |
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| Institution: | 1. University of Louisville, School of Public Health & Information Sciences, Department of Epidemiology & Population Health, James Graham Brown Cancer Center, Louisville, KY, USA;2. University of Louisville, School of Public Health & Information Sciences, Department of Bioinformatics and Biostatistics, Louisville, KY, USA;3. University of Louisville, Department of Mathematics, Louisville, KY, USA;4. University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA;5. University of Louisville, School of Medicine, Departments of Community and Geriatric Medicine, Obstetrics & Gynecology, Louisville, KY, USA;6. University of Louisville, School of Public Health and Information Sciences, Departments of Epidemiology & Population Health and Health Promotion & Behavioral Health Sciences, Louisville, KY, USA;7. University of Louisville, School of Engineering, Department of Bioengineering, Louisville, KY, USA;1. Directorate for Health Information and Research, 95, G’mangia Hill, G’mangia, PTA 1313, Malta;2. Cancer Research UK Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK;1. Division of Internal Medicine, East Carolina University, Greenville, NC, USA;2. Division of Gastroenterology, Hepatology and Nutrition, East Carolina University, Greenville, NC, USA;1. Department of Medicine, Baylor College of Medicine, Houston, TX, USA;2. Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael. E DeBakey VA Medical Center, Houston, TX, USA;3. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA;4. Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA;5. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA;6. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom;7. Department of Cancer Biology, Department of GI Medical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, TX, USA;8. Texas Medical Center Digestive Disease Center, Houston, TX, USA;9. Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, TX, USA;10. Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX, USA;11. Michael E. DeBakey VA Medical Center, Houston, TX, USA;1. School of Health Sciences, University of Tampere, Tampere, Finland;2. Tampere University Hospital, Lahti Unit of Radiation Therapy, Lahti, Finland;3. Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway;4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;5. Icelandic Cancer Registry, Reykjavik, Iceland;6. Faculty of Medicine, University of Iceland, Reykjavik, Iceland;7. Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland;8. Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway;9. Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland;1. Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health. Avenida Monforte de Lemos 5, 28029, Madrid, Spain;2. Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain;3. Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Manuel de Falla 1, 28222, Madrid, Spain;4. Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz. Arzobispo Morcillo 4, 28029, Madrid, Spain;5. Urology Department, Hospital Germans Trias i Pujol. Carretera de Canyet, S/N, 08916 Badalona, Barcelona, Spain;6. Universidad de Cantabria – IDIVAL, Avenida Cardenal Herrera Oria s/n, 39011, Santander, Spain;7. Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA)-Granada Health Research Institute (ibs.GRANADA), Doctor Azpitarte 4 4ª Planta, Edificio Licinio de la Fuente, 18012, Granada, Spain;8. Department of Preventive Medicine and Public Health, University of Granada. Avenida de la Investigación 11, 18016, Granada, Spain;9. Urology Department, La Fe University Hospital, Avinguda de Fernando Abril Martorell 106, 46026 Valencia, Spain;10. Centro de Investigación en Salud y Medio Ambiente (CYSMA), Universidad de Huelva. Campus Universitario de El Carmen, 21071 Huelva, Spain;11. Instituto Universitario de Oncología, Universidad de Oviedo. Facultad de Medicina, Planta 7, Campus de El Cristo B, 33006, Oviedo, Asturias, Spain;12. Urology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain;13. Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain;14. Laboratory and Department of Urology, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain;15. Centre de Recerca Biomèdica CELLEX, Carrer del Rosselló, 149, 08036, Barcelona, Spain;p. Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, 08003, Barcelona, Spain;q. IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003, Barcelona, Spain;r. Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003, Barcelona, Spain;1. KU Leuven – University of Leuven, Department of Oncology, Herestraat 49, B-3000 Leuven, Belgium;2. University Hospitals Leuven, Department of Radiation Oncology, Herestraat 49, B-3000 Leuven, Belgium;3. Belgian Cancer Registry, Koningsstraat 215 bus 7, B-1210 Brussels, Belgium;4. KU Leuven – University of Leuven, Department of Abdominal Surgery, Herestraat 49, B-3000 Leuven, Belgium |
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| Abstract: | BackgroundCervical cancer screening, regardless of HPV vaccination, is a cornerstone of cancer prevention. This study evaluated associations between prior HPV vaccine doses and initiation and continued participation of screening by age at vaccination.MethodsUsing electronic medical records for a safety net healthcare system (Truman Medical Center), women aged 14?26 y vaccinated (n = 1123) between 07/01/2006 and 10/1/2009 were randomly selected and matched on birth year and health campus to unvaccinated (n = 1123) women. Frequency of screening was determined through 07/01/2013. Hazard ratios (HR) for screening were estimated using Cox proportional hazards regression.ResultsScreening rates were higher after vaccination: unvaccinated (53%), first (62%), second (59%) or third (61%) doses. Women who initiated screening were less likely to complete the vaccine series, regardless of age. Women receiving one dose were more likely than unvaccinated women to initiate screening (HR = 2.98 95% Confidence Interval (CI):2.45?3.61) and were more likely to screen than those receiving two (1 vs. 2, HR = 2.94 95% CI:2.09?4.14) or three doses (1 vs. 3, HR = 3.15 95% CI:2.21?4.48). Compared to unvaccinated women, women <21 y who completed 3-doses were 1.8-times more likely to screen at ?21 y, whereas vaccinated women ?21 y were more likely to screen regardless of number of doses (p < 0.0001).ConclusionsWomen who were vaccinated were more likely to screen than unvaccinated women; screening rate was highest after and occurred closest to the first vaccine dose. Research evaluating the efficacy of a one-dose vaccine is warranted and may provide both higher vaccination and screening rates. |
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| Keywords: | Cervical cancer screening Gardasil Cervarix HPV vaccine Cox proportional hazards Compliance |
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