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Research

Effect of human papillomavirus vaccination on cervical cancer screening in Alberta

Jong Kim, Christopher Bell, Maggie Sun, Gordon Kliewer, Linan Xu, Maria McInerney, Lawrence W. Svenson and Huiming Yang
CMAJ September 06, 2016 188 (12) E281-E288; DOI: https://doi.org/10.1503/cmaj.151528
Jong Kim
Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta.
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Christopher Bell
Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta.
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Maggie Sun
Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta.
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Gordon Kliewer
Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta.
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Linan Xu
Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta.
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Maria McInerney
Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta.
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Lawrence W. Svenson
Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta.
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Huiming Yang
Public Health and Preventive Medicine Residency Program (Kim), Cumming School of Medicine, University of Calgary, Calgary; Surveillance and Assessment Branch (Bell, Svenson), Alberta Health, Edmonton; Screening Programs (Sun, Kliewer, Xu, McInerney, Yang), Alberta Health Services, Calgary; School of Public Health (Svenson), University of Alberta, Edmonton; Department of Community Health Sciences (Svenson), Cumming School of Medicine, University of Calgary, Alta.
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  • For correspondence: Huiming.Yang@albertahealthservices.ca
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Abstract

Background: A school-based program with quadrivalent human papillomavirus (HPV) vaccination was implemented in Alberta in 2008. We assessed the impact of this program on Pap test cytology results using databases of province-wide vaccination and cervical cancer screening.

Methods: We conducted a nested case–control study involving a cohort of women in Alberta born between 1994 and 1997 who had at least 1 Pap test between 2012 and 2015. Women with negative cytology results were controls. Women with low-grade (atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion) and high-grade (atypical squamous cells, cannot rule out a high-grade lesion; or high-grade squamous intraepithelial lesion) cervical abnormalities were cases. Exposure status was assigned according to records of HPV vaccination. Odds ratios (ORs) for abnormal cytology results by vaccination status were adjusted for neighbourhood income, laboratory service, rural versus urban residency, and age.

Results: The total study population was 10 204. Adjusting for age, vaccinated women had a higher screening rate than unvaccinated women (13.0% v. 11.4%, p < 0.001). Among women who received full vaccination (≥ 3 doses), the adjusted OR for cervical abnormalities was 0.72 (95% confidence interval [CI] 0.63–0.82). For high-grade lesions, the adjusted OR was 0.50 (95% CI 0.30–0.85). With 2-dose HPV vaccination, the adjusted OR for cervical abnormalities was 1.08 (95% CI 0.84–1.38).

Interpretation: Quadrivalent HPV vaccination significantly reduced high-grade cervical abnormalities but required 3 doses. Vaccination against HPV was associated with screening uptake. Population-based vaccination and screening programs should work together to optimize cervical cancer prevention.

  • Received July 4, 2016.
  • Accepted March 22, 2016.
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Canadian Medical Association Journal: 188 (12)
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Effect of human papillomavirus vaccination on cervical cancer screening in Alberta
Jong Kim, Christopher Bell, Maggie Sun, Gordon Kliewer, Linan Xu, Maria McInerney, Lawrence W. Svenson, Huiming Yang
CMAJ Sep 2016, 188 (12) E281-E288; DOI: 10.1503/cmaj.151528

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Effect of human papillomavirus vaccination on cervical cancer screening in Alberta
Jong Kim, Christopher Bell, Maggie Sun, Gordon Kliewer, Linan Xu, Maria McInerney, Lawrence W. Svenson, Huiming Yang
CMAJ Sep 2016, 188 (12) E281-E288; DOI: 10.1503/cmaj.151528
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