The quadrivalent human papillomavirus vaccine provides effective and durable protection against invasive cervical cancer

1. In this cohort study, the quadrivalent human papillomavirus (HPV) vaccine provides strong, long-lasting protection against invasive cervical cancer, with the greatest benefit if vaccination occurs before age 17. 

Evidence Rating Level: 2 (Good) 

Persistent risk with high-risk human papillomavirus (HPV) types is the main cause of invasive cervical cancer, and HPV vaccination is highly preventative and reduces cervical cancer risk. Sweden introduced the quadrivalent HPV vaccine in 2006, first through paid-access, then through subsidized programs, and eventually through school-based programs. Eventually, the program expanded to include catch-up vaccination and later transitioned from a three-dose to a two-dose schedule, before switching to the nonavalent vaccine in 2019. Previous studies have shown reductions in cervical cancer following HPV vaccination; however, there is limited clinical evidence on how durable this protection is long-term. This study seeks to evaluate how long protection lasts and how cervical cancer incidence has changed at the population level since the introduction of vaccination programs. The primary outcome was the diagnosis of invasive cervical cancer, assessed via the Swedish Cancer Registry. The study included 926,362 individuals, of whom 365,502 (39.5%) received at least one quadrivalent HPV vaccine dose. There were 930 invasive cervical cancer cases, with 97 in vaccinated women and 833 in unvaccinated women. Vaccination before the age of 17 was associated with an incidence rate ratio (IRR) of 0.21 (95% CI, 0.13-0.31), with protection sustained for 13-15 years after vaccination (IRR 0.23, 95% CI, 0.11-0.46). Those vaccinated at 17 or older had an overall IRR of 0.63 (95% CI, 0.49-0.81), with significant reductions during years 10-12 (IRR 0.54, 95% CI 0.33-0.86) and years 13-15 (IRR 0.23, 95% CI, 0.08-0.60). Overall, this study reinforced that the HPV vaccination is highly effective, durable, and most impactful when delivered early.

Click here to read this study in BMJ

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