# Swedish registry study: HPV vaccination almost eliminates cervical cancer when given before 17

Source: https://onco.cc/key-papers/paper-hpv-vaccine-sweden-nejm-2020/  
OnCo record `paper-hpv-vaccine-sweden-nejm-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Among 1.7 million Swedish girls and women, quadrivalent HPV vaccination cut invasive cervical cancer by 88% when given before age 17 and by about half when given at 17-30.

## Summary

A nationwide cohort of 1,672,983 girls and women aged 10-30 was followed from 2006 to 2017 through Swedish registries, linking HPV vaccination status to invasive cervical cancer diagnoses. Analyses adjusted for age, calendar year, county and parental characteristics.

Cumulative incidence of cervical cancer by age 30 was 47 per 100,000 in vaccinated women and 94 per 100,000 in unvaccinated women. The adjusted incidence rate ratio was 0.12 for women vaccinated before 17 and 0.47 for those vaccinated at 17-30.

This was the first population-level demonstration that HPV vaccination prevents invasive cancer, not just precancerous lesions.

## Fields

- Kind: Key paper
- Last checked: 2026-09-08
- Journal: New England Journal of Medicine
- Year: 2020
- DOI: 10.1056/NEJMoa1917338
- Authors: Lei J, Ploner A, Elfström KM, et al.
- Findings: Adjusted incidence rate ratio for cervical cancer 0.37 (95% CI 0.21-0.57) overall in vaccinated vs unvaccinated; Vaccinated before age 17: IRR 0.12 (95% CI 0.00-0.34), an 88% reduction; Vaccinated at 17-30: IRR 0.47 (95% CI 0.27-0.75); Cumulative incidence by age 30: 47 vs 94 per 100,000
- What it means: Vaccinating girls before they are exposed to HPV prevents most cervical cancers. Catch-up vaccination in young adults still helps, but less. Combined with HPV screening, elimination of cervical cancer as a public health problem is a realistic goal.
- Caveats: Observational; residual confounding by health-seeking behaviour is possible despite adjustment; Follow-up ends at age 30, before most cervical cancers occur; Sweden used the quadrivalent vaccine; effects for bivalent and nonavalent vaccines are inferred; Does not address single-dose schedules or vaccination of boys

## Sources

- DOI: https://doi.org/10.1056/NEJMoa1917338

## Connected records

- key papers: [England's HPV programme: cervical cancer down 87% in the first cohort vaccinated at 12-13](https://onco.cc/key-papers/paper-hpv-vaccine-england-lancet-2021/)
- ideas: [Community-tailored HPV vaccine confidence campaigns with school-based delivery](https://onco.cc/ideas/idea-moon-hpv-vaccine-confidence/), [Single-dose HPV vaccination plus HPV self-sampling to reach WHO elimination in low-income countries](https://onco.cc/ideas/idea-single-dose-hpv-self-sampling-elimination/), [Switch every country to single-dose HPV vaccination and add catch-up to age 26](https://onco.cc/ideas/idea-prev-hpv-single-dose-switch-catchup/)
- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/)
- fronts: [Prevention & Risk](https://onco.cc/fronts/prevention/)
- technologies: [HPV & HBV vaccination](https://onco.cc/technologies/hpv-vaccine/), [HPV DNA testing and self-sampling](https://onco.cc/technologies/hpv-testing/)
- institutions: [Karolinska University Hospital](https://onco.cc/institutions/karolinska/)
- bottlenecks: [Misinformation and unproven therapies](https://onco.cc/bottlenecks/b-misinformation/), [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)
- people: [Nubia Muñoz](https://onco.cc/people/nubia-munoz/)

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