Trends in cervical intraepithelial neoplasia Grade 2+ after human papillomavirus vaccination: The devil is in the details
Menée à partir des données 2008-2012 du réseau de surveillance sanitaire "HPV-IMPACT" portant sur des populations de 4 états américains ayant introduit la vaccination précoce contre le papillomavirus humain (Californie, Connecticut, New York et Oregon), cette étude analyse l'évolution de l'incidence de lésions cervicales de haut grade et des taux de participation au dépistage du cancer du col de l'utérus en fonction de trois catégories d'âges (18-20 ans, 21-29 ans, 30-39 ans)
Eight years since the introduction of the adolescent HPV vaccination programs, as the vaccinated cohort enters adulthood, the impact of these vaccination programs is now being assessed through surrogate markers such as the incidence of high-grade cervical dysplasia (cytology/histology) and the incidence of genital warts. Early data from the HPV-IMPACT study shows that although there has been a noticeable drop in CIN2+ incidence rates, the results may be confounded by the recent changes in cervical screening guidelines. This study is significant in that it is the first to report on changes in high-grade histological abnormalities in the postvaccination era. Despite the confounding effect of changing cervical cancer screening guidelines, the findings cannot be completely ignored. With wider acceptance and standardization of cervical cancer screening guidelines and with an increasing number of women entering the vaccinated cohort, the magnitude of vaccine effectiveness should become more obvious. Further studies are needed to assess the changes in high-grade histological abnormalities in the post-vaccine era.
Cancer , éditorial, 2014