England's HPV programme: cervical cancer down 87% in the first cohort vaccinated at 12-13
Ten years after England began vaccinating 12- to 13-year-olds with the bivalent HPV vaccine, cervical cancer in that cohort had fallen by 87% and severe precancer (CIN3) by 97%.
A population-based observational study used English cancer registry data from 2006 to 2019 to compare cervical cancer and CIN3 rates in cohorts offered the bivalent vaccine (Cervarix) at ages 12-13, 14-16 and 16-18 with earlier, unvaccinated cohorts, adjusting for changes in screening.
Relative reductions in cervical cancer were 87% in the cohort offered vaccination at 12-13, 62% at 14-16 and 34% at 16-18. CIN3 fell by 97%, 75% and 39% respectively. The authors estimated about 450 fewer cervical cancers and 17,200 fewer CIN3 cases by mid-2019.
This confirmed the Swedish finding with a different vaccine and a school-based programme with high coverage.
- Cervical cancer reduced 87% (95% CI 72-94) in the cohort offered vaccine at age 12-13
- Reduction of 62% (52-71) at 14-16 and 34% (25-41) at 16-18
- CIN3 reduced 97% (96-98) in the youngest cohort
- An estimated 448 fewer cervical cancers and 17,235 fewer CIN3 cases by June 2019
School-based vaccination at 12-13 with high uptake nearly abolishes cervical cancer in vaccinated cohorts, even with a vaccine covering only two HPV types. Screening intervals and the future of cervical screening can now be redesigned around vaccination status.
- Observational with a cohort comparison; changes in screening policy were adjusted for but cannot be fully excluded
- Vaccinated cohorts were still young (under 28), so absolute numbers of cancers were small
- Bivalent vaccine; England later switched to quadrivalent and nonavalent
- Effects in populations with lower coverage will be smaller
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