Human papillomavirus vaccination may allow longer cervical cancer screening intervals

1. In this individual-based modeling study, fewer cervical cancer screens for HPV-vaccinated women were the most cost-effective strategy.

2. Fewer screens also preserved a favorable harm–benefit ratio comparable to current guidelines.

Evidence Rating Level: 2 (Good)

Study Rundown: The identification of human papillomavirus (HPV) as the causal agent of cervical cancer (CC) has led to HPV vaccination and the widespread adoption of HPV-based screening. However, variation in vaccine uptake, timing, and formulation results in heterogeneous CC risk depending on whether, when, and with which vaccine individuals were immunized. This study evaluated the cost-effectiveness and harm–benefit trade-offs of tailoring CC screening strategies based on age at HPV vaccination. Among individuals vaccinated by age 30, extending screening intervals beyond the 5-year interval recommended in current guidelines was the most cost-effective approach, though optimal strategies varied by vaccination age. Women vaccinated after age 25 could be screened less frequently, while those vaccinated at younger ages would require fewer lifetime screens through delayed screening initiation and longer intervals between tests. Extended-interval strategies remained cost-effective even under assumptions of imperfect vaccine adherence and absence of cross-protection from bivalent vaccines, with consistent findings across lower and higher cost-effectiveness thresholds. Maintaining a favorable harm–benefit ratio comparable to current guidelines similarly required screening intervals longer than 5 years. Comparable ratios were observed for 10-year screening intervals among women vaccinated between ages 25 and 30, and for three lifetime screens among women vaccinated between ages 19 and 24. Generalizability is limited by the lack of data on unvaccinated women, who may still benefit from herd immunity. Overall, these findings suggest that extending and individualizing CC screening intervals for HPV-vaccinated women based on vaccination history can reduce costs without increasing population-level harm.

Click to read this study in AIM

Relevant Reading: Optimal Cervical Cancer Screening in Women Vaccinated Against Human Papillomavirus

In-Depth [modeling study]: This individual-based mathematical modeling study evaluated the cost-effectiveness and harm–benefit trade-offs of tailoring cervical cancer (CC) screening recommendations based on age at HPV vaccination. A simulated cohort of women from age 12 was followed monthly, with analyses stratified by age group and vaccine type (bivalent [2vHPV] or nonavalent [9vHPV]) to assess strategies varying in screening initiation, interval, and total lifetime tests. The primary outcome was the incremental cost-effectiveness ratio (ICER), defined as the additional cost per quality-adjusted life year (QALY) gained, with a threshold of $55,000/QALY. Across vaccination ages, the most cost-effective approach involved extending screening intervals beyond the 5 years recommended in current guidelines. Women vaccinated at 25–30 (either vaccine) could be screened every 10 years, reducing lifetime tests, while those vaccinated at younger ages required only 2–3 lifetime screens by delaying the first screen and lengthening intervals. For instance, women vaccinated at 22–24 achieved optimal outcomes with three lifetime screens, all with ICERs below the threshold. Cost-effective strategies reduced lifetime costs by up to 76% for some younger vaccination groups and were at least 54% likely to be cost-effective, reaching 100% probability for women vaccinated at 25 or older. Extended-interval strategies remained cost-effective under imperfect vaccine adherence or limited cross-protection, and were also preferred at lower ($40,000/QALY) and higher ($90,000/QALY) thresholds. The secondary outcome was the harm–benefit ratio, defined as additional colposcopy referrals per additional CC case prevented, with a benchmark of 47.5 colposcopies per case averted. Prolonging intervals maintained favorable ratios comparable to current guidelines: a 10-year interval for women vaccinated at 25–30 achieved similar ratios, while younger vaccinated women required 3–4 lifetime screens. Maintaining 5-year intervals would increase harm–benefit ratios several-fold. Overall, these findings suggest that for HPV-vaccinated women, cost-effective CC screening strategies involve substantially fewer tests than current guidelines, with extended intervals preserving health benefits while reducing costs and harm.

Image: PD

©2026 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.