DCU research finds that cervical cancer screening is more effective with increased HPV vaccination rates

New research led by Dublin City University has found that increasing HPV (human papillomavirus) vaccination rates in parallel with a cervical cancer screening programme, ultimately makes screening more effective and also reduces unnecessary surgical interventions.

In Ireland, each year over 300 women are diagnosed with cervical cancer, and it is the second most common cause of death among women aged 25-39 years. 

Almost all cases of cervical cancer are caused by HPV, the name attributed to a very common group of viruses. Screening for cervical cancer is regarded as a lifesaving intervention, with a number of approaches including liquid-based cytology (LBC) and testing for human papillomavirus (HPV) infection. 

The research team examined the likely outcomes from different screening modes and how the uptake of the HPV vaccine could affect the interpretation of screening results.

Using a Markov model approach to estimate likely outcomes in a hypothetical cohort of 1000 women aged 25 years or older, the authors found that human papilloma virus (HPV) detection methods reduce unnecessary interventions by a factor of 10, making cervical screening much more effective. 

Crucially, as HPV vaccination increases, these approaches remain robust and keep screening future proof. Remarking on the findings lead author Dr David Robert Grimes, Assistant Professor in Biomedical Physics at DCU points out that the research reaffirms that “screening is a life-saving endeavour, and HPV vaccination has been an absolute game changer. Together, they have the potential to banish the spectre of cervical cancer to history.”

He also noted that “There are many approaches to screening, and with the incredible impact of the HPV vaccine already being seen worldwide, it is reassuring that modelling suggests HPV-screening approaches remain effective even as HPV infections diminish.”

The research found that HPV modalities outperformed the LBC based approaches by up to 19%. It highlighted that while cotesting reduced missed cases, detecting 29% more true positives than LBC alone, it also increased colonoscopy referrals by up to 94%.

The study showed that over a lifetime of screening, reflex approaches (where results are triaged according to HPV status ) with appropriate test intervals increased therapeutic efficacy, and as HPV rates increased it resulted in fewer unnecessary colposcopies.

The research also modelled HPV vaccination and its impact on screening, considering a future where cervical cancer might be virtually eradicated, finding that HPV modalities for screening, such as that in use in Ireland are “future proof and robust.” 

The authors noted that the effectiveness of cervical screening was dependent on the prevalence of cervical dysplasia (pre-cancerous condition in which abnormal cell growth occurs on the lining of the cervix) and/or HPV infection or vaccination in a population as well as the sensitivity and specificity of various modalities. 

Modeling Cervical Cancer Screening Strategies With Varying Levels of Human
Papillomavirus Vaccination. Authors: David Robert Grimes, PhD; Edward M. A. Corry, MD; Talía Malagón, PhD; Ciaran O’Riain, MD, PhD; Eduardo L. Franco, DrPH; Donal J. Brennan, MD, PhD is published on JAMA Network Open.