HPV Vaccination and the Risk of Invasive Cervical Cancer
Open accessAbstract
BACKGROUND: The efficacy and effectiveness of the quadrivalent human papillomavirus (HPV) vaccine in preventing high-grade cervical lesions have been shown. However, data to inform the relationship between quadrivalent HPV vaccination and the subsequent risk of invasive cervical cancer are lacking. METHODS: We used nationwide Swedish demographic and health registers to follow an open population of 1,672,983 girls and women who were 10 to 30 years of age from 2006 through 2017. We assessed the association between HPV vaccination and the risk of invasive cervical cancer, controlling for age at follow-up, calendar year, county of residence, and parental characteristics, including education, household income, mother's country of birth, and maternal disease history. RESULTS: During the study period, we evaluated girls and women for cervical cancer until their 31st birthday. Cervical cancer was diagnosed in 19 women who had received the quadrivalent HPV vaccine and in 538 women who had not received the vaccine. The cumulative incidence of cervical cancer was 47 cases per 100,000 persons among women who had been vaccinated and 94 cases per 100,000 persons among those who had not been vaccinated. After adjustment for age at follow-up, the incidence rate ratio for the comparison of the vaccinated population with the unvaccinated population was 0.51 (95% confidence interval [CI], 0.32 to 0.82). After additional adjustment for other covariates, the incidence rate ratio was 0.37 (95% CI, 0.21 to 0.57). After adjustment for all covariates, the incidence rate ratio was 0.12 (95% CI, 0.00 to 0.34) among women who had been vaccinated before the age of 17 years and 0.47 (95% CI, 0.27 to 0.75) among women who had been vaccinated at the age of 17 to 30 years. CONCLUSIONS: Among Swedish girls and women 10 to 30 years old, quadrivalent HPV vaccination was associated with a substantially reduced risk of invasive cervical cancer at the population level. (Funded by the Swedish Foundation for Strategic Research and others.).
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HPV vaccines have demonstrated high efficacy for three-dose and two-dose schedules.
“The licensed prophylactic human papillomavirus (HPV) vaccines protect against infection with vaccine-targeted HPV types, precancerous lesions, and invasive cervical cancer, have demonstrated high efficacy for three-dose and two-dose schedules,3, 4 and have consistently been shown to be safe.5”
From Evidence-based impact projections of single-dose human papillomavirus vaccination in India: a modelling study (2022) · cites this paper as [3]
The HPV Vaccination section (page not provided) says Sweden used a three-dose schedule from 2006 and a two-dose schedule for school-based programs from 2015. The Discussion reports established HPV vaccine efficacy, but this study classified anyone receiving at least one dose as vaccinated and did not report efficacy separately for the two schedules. It therefore does not establish high efficacy for each schedule. (LLM, conf=0.86)
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- Authors
- Lei, J., Ploner, A., Elfström, K. M., Wang, J., Roth, A., Fang, F., Sundström, K., Dillner, J., & Sparén, P.
- Affiliations
- Public Health Agency of Sweden (SE)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2020-10
- Volume
- 383
- Issue
- 14
- Pages
- 1340-1348
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W3090300247
- Cited by
- 1,487
- References
- 2
- Citations by year
- 2026: 210 · 2025: 258 · 2024: 239 · 2023: 272 · 2022: 251 · 2021: 241 · 2020: 13 · 2015: 1
- FWCI
- 139.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Stiftelsen för Strategisk Forskning (KF10-0046)
- Cancerfonden (CAN 2016/840)
- Vetenskapsrådet (2017-02346)
- China Scholarship Council (201507930001)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- HPV vaccination, quadrivalent HPV vaccine, invasive cervical cancer, cervical cancer incidence, vaccine effectiveness, age at vaccination, cervical cancer prevention, women of reproductive age
- MeSH terms
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18, Adolescent, Adult, Uterine Cervical Neoplasms, Child, Female, Follow-Up Studies, Humans, Neoplasm Invasiveness, Registries, Sweden, Vaccination, Cohort Studies, Incidence, Immunization Programs, Young Adult
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