HPV Vaccination and the Risk of Invasive Cervical Cancer
HPV Vaccination and the Risk of Invasive Cervical Cancer
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DOI：
10.1056/nejmoa1917338
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发表时间：
2020-10-01
影响因子：
158.5
通讯作者：
Sparen, Par
中科院分区：
文献类型：
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作者：
Lei, Jiayao;Ploner, Alexander;Sparen, Par
研究背景四价人乳头瘤病毒（HPV）疫苗在预防高度宫颈病变中的有效性和安全性已得到证实。然而，数据告知四价HPV疫苗接种和随后的侵袭性宫颈癌的风险之间的关系是缺乏的。MethodsWe使用全国范围内的瑞典人口和健康登记册，以遵循开放的人口1，672，983女孩和妇女谁是10至30岁，从2006年至2017年。我们评估了HPV疫苗接种和浸润性宫颈癌的风险之间的关联，控制随访时的年龄，日历年，居住县，和父母的特征，包括教育，家庭收入，母亲的出生国，和孕产妇疾病history.ResultsDuring研究期间，我们评估的女孩和妇女宫颈癌，直到他们的31岁生日。在接受四价HPV疫苗的19名妇女和未接受疫苗的538名妇女中诊断出宫颈癌。在已接种疫苗的妇女中，宫颈癌累积发病率为每10万人中有47例，在未接种疫苗的妇女中，宫颈癌累积发病率为每10万人中有94例。在调整随访时的年龄后，接种人群与未接种人群比较的发病率比值为0.51（95%置信区间[CI]，0.32 - 0.82）。对其他协变量进行额外校正后，发生率比为0.37（95% CI，0.21 - 0.57）。校正所有协变量后，发生率比值为0.12（95% CI，0.00 - 0.34）在17岁之前接种疫苗的女性中，（95%CI，0.27至0.75）在17至30岁接种疫苗的妇女中。在人群水平上，四价HPV疫苗接种与大幅降低侵袭性宫颈癌的风险相关。（由瑞典战略研究基金会和其他机构资助。在这项瑞典登记研究中，四价人乳头瘤病毒疫苗接种与30岁以下女孩和妇女浸润性宫颈癌风险大幅降低相关。
BackgroundThe 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.MethodsWe 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.ResultsDuring 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.ConclusionsAmong 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.)In this Swedish registry study, quadrivalent human papillomavirus vaccination was associated with a substantially reduced risk of invasive cervical cancer among girls and women up to 30 years of age.