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Title: Potential for HPV vaccination and primary HPV screening to reduce cervical cancer disparities: Example from New Zealand
Authors: Smith MA; Hall M; Lew JB; Canfell K
Categories: Cancer Type - Cervical Cancer
Cancer Control, Survivorship, and Outcomes Research - Health Services, Economic and Health Policy Analyses
Year: 2018
Journal Title: Vaccine
Volume: 36
Issue: 42
Page number start: 6314
Page number end: 6324
Abstract: Background Cervical cancer rates are over twice as high, and screening coverage is lower, in Māori women compared to other women in New Zealand, whereas uptake of HPV vaccine is higher in Maori females. We aimed to assess the impact of HPV vaccination and the proposed transition to 5-yearly primary HPV screening in Māori and other women in New Zealand, at current participation levels; and additionally to investigate which improvements to participation in Māori females (in vaccination, screening, or surveillance for screening-defined higher-risk women) would have the greatest impact on cervical cancer incidence/mortality. Methods An established model of HPV vaccination and cervical screening in New Zealand was adapted to fit observed ethnicity-specific data. Ethnicity-specific models were used to estimate the long-term impact of vaccination and screening (vaccination coverage 63% vs 47%; five-year screening coverage 68% vs 81% in Maori vs European/Other women, respectively). Results Shifting from cytology to HPV-based screening is predicted to reduce cervical cancer incidence by 17% (14%) in Maori (European/Other) women, respectively. The corresponding reductions due to vaccination and HPV-based screening combined were 58% (44%), but at current participation levels long-term incidence would remain almost twice as high in Māori women (6.1/100,000 compared to 3.1/100,00 in European/Other women). Among strategies we examined, the greatest impact came from high vaccine coverage and achieving higher attendance by Māori women under surveillance for screen-detected abnormalities. Conclusion Relative reductions in cervical cancer due to vaccination and HPV-based screening are predicted to be greater in Maori than in European/Other women. While these interventions have the potential to substantially reduce between-group differences, cervical cancer incidence would remain higher in Maori women. These findings highlight the importance of multiple approaches and the potential influence of factors beyond HPV prevention.
Division: Cancer Research Division
Funding Body: This work was supported by the National Screening Unit, New Zealand. KC receives salary support from NHMRC Australia (Career Development Fellowship APP1082989)
DOI: 10.1016/j.vaccine.2018.08.063
Appears in Collections:Research Articles

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