Abstract Background We investigated the impact of human papillomavirus (HPV) vaccination on the performance of cytology-based and HPV-based screening for detection of cervical precancer among women vaccinated as young adults and reaching screening age. Methods A total of 4632 women aged 25-36 years from the Costa Rica HPV Vaccine Trial were included (2418 HPV-vaccinated as young adults and 2214 unvaccinated). We assessed the performance of cytology- and HPV-based cervical screening modalities in vaccinated and unvaccinated women to detect high-grade cervical precancers diagnosed over 4 years and the absolute risk of cumulative cervical precancers by screening results at entry. Results We detected 95 cervical intraepithelial neoplasia grade 3 or worse (52 in unvaccinated and 43 in vaccinated women). HPV16/18/31/33/45 was predominant (69%) among unvaccinated participants, and HPV35/52/58/39/51/56/59/66/68 predominated (65%) among vaccinated participants. Sensitivity and specificity of cervical screening approaches were comparable between women vaccinated as young adults and unvaccinated women. Colposcopy referral rates were lower in the vaccinated group for HPV-based screening modalities, but the positive predictive value was comparable between the 2 groups. Conclusions Among women approaching screening ages, vaccinated as young adults, and with a history of intensive screening, the expected reduction in the positive predictive value of HPV testing, associated with dropping prevalence of HPV-associated lesions, was not observed. This is likely due to the presence of high-grade lesions associated with nonvaccine HPV types, which may be less likely to progress to cancer.

中文翻译：

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HPV 疫苗接种十年后宫颈筛查的表现：哥斯达黎加疫苗试验


摘要背景我们研究了人乳头瘤病毒 (HPV) 疫苗接种对年轻时接种疫苗并达到筛查年龄的女性中基于细胞学和 HPV 的宫颈癌前病变筛查效果的影响。方法哥斯达黎加 HPV 疫苗试验共纳入了 4632 名 25-36 岁女性（其中 2418 名年轻时接种了 HPV 疫苗，2214 名未接种疫苗）。我们评估了基于细胞学和 HPV 的宫颈筛查方式在接种疫苗和未接种疫苗的女性中的表现，以检测 4 年内诊断出的高级别宫颈癌前病变，并通过入组时的筛查结果来检测累积宫颈癌前病变的绝对风险。结果 我们检测到 95 例 3 级或更严重的宫颈上皮内瘤变（52 例为未接种疫苗的女性，43 例为接种疫苗的女性）。在未接种疫苗的参与者中，HPV16/18/31/33/45 占主导地位 (69%)，在接种疫苗的参与者中，HPV35/52/58/39/51/56/59/66/68 占主导地位 (65%)。年轻时接种疫苗的女性和未接种疫苗的女性之间宫颈筛查方法的敏感性和特异性相当。对于基于 HPV 的筛查方式，接种疫苗组的阴道镜转诊率较低，但两组之间的阳性预测值相当。结论在接近筛查年龄、年轻时接种疫苗且有强化筛查史的女性中，没有观察到 HPV 检测阳性预测值的预期降低（与 HPV 相关病变患病率下降相关）。 这可能是由于存在与非疫苗 HPV 类型相关的高级病变，这些病变不太可能进展为癌症。