Human papillomavirus is a well-known cause of various cancers, including cervical cancer. In the U.S., current guidance from the Centers for Disease Control and Prevention for HPV vaccination recommends a two-dose series for all people ages 11-12 years old. The Advisory Committee on Immunization Practices also recommends that anyone through age 26 get a two- or three-dose series (depending on age) if not done when younger. Some adults ages 27-45 can opt for vaccination after shared decision making with their physician. The prevailing thought is that most people have been exposed to HPV by adulthood, so “vaccination does not need to be discussed with most adults over age 26 years,” the guidance says.
A new study out of the Czech Republic, published in The Lancet Regional Health - Europe, looks at another use of HPV vaccination. A cohort study examined a laboratory database that processes about 33% of women undergoing cervical cancer screening in the country. They looked at patients who had cervical intraepithelial neoplasia grade 2 or worse (CIN2+), focusing on those with positive margins, and followed for recurrence. They compared people who got vaccinated prophylactically or post-conization (which has been recommended by the Czech Gynaecological and Obstetrical Society since 2008).
There were 502 patients with prophylactic vaccination, 919 had post-conization vaccination, and 169 had vaccination of unknown timing. Patients were followed for up to 15 years post-conization. As a baseline, the recurrence rate of all unvaccinated patients (with and without positive margins) was 14.61 per 1,000 patient years. Recurrent rates were 5.84 in those with prophylactic vaccination and 3.37 in those with post-conization vaccination. This correlates to a recurrence reduction of 54% in prophylactic vaccinees and 74% in the post-conization vaccinees; the difference between these two rates was not statistically significant.
In those with positive margins, the unvaccinated had a recurrence rate of 51.62 per 1,000 patient years. Prophylactic vaccinees had a recurrence rate of 14.94 (a 62% reduction, which did not reach statistical significance), and post-conization vaccinees had a rate of 9.78 (a 79% reduction).
In unvaccinated patients and those with prophylactic vaccination, increasing age corresponded to increasing risks of recurrence; but this trend was not seen in those with post-conization vaccination.
The American College of Obstetricians and Gynecologists published 2023 guidance that supports consideration of vaccination in these patients with an upper age limit of 45. Similarly, the American Society for Colposcopy and Cervical Pathology recommends shared clinical decision making regarding vaccination in those 27-45 years old with CIN2+. Based on this large Czech review, it seems that recommending routine vaccination in all patients with CIN2+, regardless of previous vaccination status, should be examined in an effort to prevent recurrence.