Impact of human papillomavirus vaccination on the clinical meaning of cervical screening results

Philip E. Castle, Xianhong Xie, Xiaonan Xue, Nancy E. Poitras, Thomas S. Lorey, Walter K. Kinney, Nicolas Wentzensen, Howard D. Strickler, Emily A. Burger, Mark Schiffman

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Women previously vaccinated against human papillomavirus (HPV) type 16 and 18 are now reaching the age (21 years) at which cervical-cancer screening is recommended in the U.S. The impact of HPV vaccination on risks of cervical precancer following a positive and negative screen among women aged 21–24 years who just started routine cervical screening are not well described. Therefore, three-year absolute and relative (RR) cumulative risks of cervical intraepithelial neoplasia grade 2 or more severe diagnoses (≥CIN2) and grade 3 or more severe diagnoses (≥CIN3) were estimated for women undergoing cervical screening at Kaiser Permanente Northern California. Risks were estimated in women aged 21–24 years (n = 75,008) undergoing cervical screening since late 2006, 6 months after HPV vaccination became available; women were categorized vaccinated at ages <18, 18–20, and 21–24 years and compared to those who were unvaccinated. Three-year risks were estimated for normal, low-grade, and high-grade cytology results. Three-year risks of ≥CIN2 and ≥CIN3 for unvaccinated women following low-grade cytology were 10.89% for and 3.70%, respectively. By comparison, Three-year risks of ≥CIN2 and ≥CIN3 were 5.26% (RR = 0.48, 95%CI = 0.24–0.99) and 0.99% (RR = 0.27, 95%CI = 0.06–1.13), respectively, for women vaccinated under the age of 18 years. Three-year ≥CIN2 and ≥CIN3 risks were lower for those HPV vaccinated at younger age for any screening result (ptrend ≤ 0.01 for all comparisons). These data support initiating cervical screening at an older age or changing the management of a low-grade cytology result in women aged 21–24 years who were vaccinated against HPV younger than age of 18 years.

Original languageEnglish (US)
Pages (from-to)44-50
Number of pages7
JournalPreventive Medicine
StatePublished - Jan 2019


  • Cervical precancer
  • Cytology
  • Human papillomavirus (HPV)
  • Screening
  • Vaccination

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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