Cervical Cancer and Grade 3 Cervical Intraepithelial Neoplasia Incidence Reduced in Young, HPV-Vaccinated Individuals

Article

Those immunized between the ages of 12 and 13 in England experienced a significant estimated reduction in cervical cancer and grade 3 cervical intraepithelial neoplasia incidence rates compared with unvaccinated women.

After introducing a human papillomavirus (HPV) immunization program, a significant reduction in cervical cancer and the incidence of grade 3 cervical intraepithelial neoplasia (CIN3) in young individuals was observed in England, according to results of a register-based observational study published in The Lancet.1

Compared with women who were unvaccinated, those who received bivalent vaccine (Cervarix) at the age of 12 to 13 years experienced an estimated relative reduction in cervical cancer rates of 87% (95% CI, 72%-94%). Risk reductions for CIN3 were 39% (95% CI, 36%-41%), 75% (95% CI, 72%-77%), and 97% (95% CI, 96%-98%) for those who were offered the vaccine at ages 16 to 18 years, ages 14 to 16 years, and ages 12 to 13 years, respectively.

“The magnitude of the reduction reported for individuals offered the vaccine in school year 8 was much greater than would be expected under that scenario and also than would be expected assuming a single dose provides 100% protection against HPV 16 and 18,” the investigators wrote.

The research team utilized 3 vaccinated cohorts accounting for the school year when women were offered the vaccine. Those cohorts included ages 12 to 13 (school year 8), ages 14 to 16 (school years 10 to 11), or ages 16 to 18 (school years 12 to 13). For each cohort, the expected reduction in cervical cancer incidence rates was 36% to 48%, 59% to 64%, and 68% to 71% in the 16 to 18 years, 14 to 16 years, and 12 to 13 years cohorts, respectively.

Cervical cancer and CIN3 incidences diagnosed among women between the ages of 20 and 64 years in England between January 1, 2006 to December 2017, January 2018 to September 2018, October 2018 to March 2019, and April 2019 to June 30, 2019, were extracted on January 26, 2021. The investigators used data from the National Cancer Registration and Analysis Service, Public Health England (PHE).

The research team also defined 7 birth cohorts, which correspond with differences in age when first invited for screening and the school year when vaccination was offered. Those cohorts included patients who were invited from age 20.0 years with no vaccine (cohort 1), invited from age 20.0 years or 25.0 years with no vaccine (cohort 2), invited from age 25.0 years with no vaccine (cohort 3), invited from age 24.5 years with no vaccine (cohort 4), invited from age 24.5 years and offered vaccination in school years 12 to 13 (cohort 5), invited from age 24.5 years and offered vaccination in school years 10 to 11 (cohort 6), and not invited before age 24.5 years and offered vaccination in school year 8 (cohort 7).

A total of 27,946 diagnoses of cervical cancer and 318,058 cases of CIN3 observed during the study period. The estimated relative risk of cervical cancer for the patient population was 34% (95% CI, 25%-41%) lower for cohort 5, and 62% (95% CI, 52%-71%) for cohort 6, and 87% (95% CI, 72%-94%) lower for cohort 7.

By June 30, 2019, the research team estimated that 448 fewer than expected cases of cervical cancer (95% CI, 339-556) and 17,235 (95% CI, 15,919-18,552) fewer cases of CIN3 took place among the vaccinated cohorts in England.

Of note, the study was limited due to the lack of individual-level data regarding vaccination status, limiting the research team’s ability to estimate individual-level efficacy. Furthermore, no information is available on the HPV type in each of the cancers.

“We hope that these new results encourage uptake as the success of the vaccination programme relies not only on the efficacy of the vaccine but also the proportion of the population vaccinated,” co-author Kate Soldan of the UK Health Security Agency, concluded.2

References

  1. Falcaro M, Castañon A, Ndlela B, et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet. Published online November 3, 2021. doi:10.1016/ S0140-6736(21)02178-4
  2. Older HPV vaccine cuts cervical cancer rate up to 87%, study finds. News release. Reuters. November 3, 2021. Accessed November 4, 2021. https://tinyurl.com/4xwkrssx
Related Videos
Brian Slomovitz, MD, MS, FACOG discusses the use of new antibody drug conjugates for treating patients with various gynecologic cancers.
Developing novel regimens may continue to improve survival outcomes of patients with advanced cervical cancer following the FDA approval of pembrolizumab and chemoradiation, says Jyoti S. Mayadev, MD.
Treatment with pembrolizumab plus chemoradiation appears to be well tolerated with no detriment to quality of life among those with advanced cervical cancer.
Jyoti S. Mayadev, MD, says that pembrolizumab in combination with chemoradiation will be seamlessly incorporated into her institution’s treatment of those with FIGO 2014 stage III to IVA cervical cancer following the regimen’s FDA approval.
Despite the addition of a TIGIT inhibitor to a checkpoint inhibitor resulting in high levels of safety, there is no future for that combination alone, according to Ritu Salani, MD.
Treatment with tisotumab vedotin may be a standard of care in second- or third-line recurrent or metastatic cervical cancer, says Brian Slomovitz, MD, MS, FACOG.
Domenica Lorusso, MD, PhD, says that paying attention to the quality of chemoradiotherapy is imperative to feeling confident about the potential addition of pembrolizumab for locally advanced cervical cancer.
Following the results of the phase 3 CALLA trial, Jyoti S. Mayadev, MD, discusses the importance of global clinical multidisciplinary efforts in the locally advanced cervical cancer space.
Related Content
Long-term circulating tumor DNA responses appear to align with progression-free survival trends in a phase 2/3 trial of the GRANITE vaccine in those with microsatellite-stable colorectal cancer.

Personalized Vaccine Yields Early PFS Benefit in Metastatic MSS-CRC

April 2nd 2024
Article

Long-term circulating tumor DNA responses appear to align with progression-free survival trends in a phase 2/3 trial of the GRANITE vaccine in those with microsatellite-stable colorectal cancer.

The FDA approval of pembrolizumab plus chemoradiation benefits patients with stage III to IVA cervical cancer based on findings from the KEYNOTE-A18 trial, according to Jyoti S. Mayadev, MD.

Jyoti S. Mayadev, MD, on Pembrolizumab/CRT FDA Approval in Cervical Cancer

January 22nd 2024
Podcast

The FDA approval of pembrolizumab plus chemoradiation benefits patients with stage III to IVA cervical cancer based on findings from the KEYNOTE-A18 trial, according to Jyoti S. Mayadev, MD.

Tislelizumab/Chemo Yields Antitumor Activity in Advanced Cervical Cancer

Tislelizumab/Chemo Yields Antitumor Activity in Advanced Cervical Cancer

March 16th 2024
Article

A phase 2 trial showed favorable antitumor activity when tislelizumab plus chemotherapy was used for patients with locally advaned cervical cancer.

Julianne Cooley, MS, spoke with CancerNetwork® about older patients with later stage cervical cancer who have lower survival rates compared with their younger counterparts.

Oncology Peer Review On-The-Go Podcast: Cervical Cancer Screenings/Survival in Those 65+ Years

February 2nd 2023
Podcast

Julianne Cooley, MS, spoke with CancerNetwork® about older patients with later stage cervical cancer who have lower survival rates compared with their younger counterparts.

Treatment with simple hysterectomy reduces the incidence of urinary incontinence compared with radical hysterectomy in patients with low-risk cervical cancer.

Simple Hysterectomy Noninferior Vs Radical Hysterectomy in Cervical Cancer

March 11th 2024
Article

Treatment with simple hysterectomy reduces the incidence of urinary incontinence compared with radical hysterectomy in patients with low-risk cervical cancer.

Tisotumab vedotin may become the first antibody drug conjugate to receive marketing authorization in the European Union as a treatment for those with cervical cancer.

EMA Validates Tisotumab Vedotin Marketing Application in Cervical Cancer

February 5th 2024
Article

Tisotumab vedotin may become the first antibody drug conjugate to receive marketing authorization in the European Union as a treatment for those with cervical cancer.