Women unlikely to adhere to screening guidelines after HPV vaccination

Women who have received the HPV vaccination were less likely to adhere to cervical cancer screening guidelines, suggesting an unintended consequence of the HPV vaccination program, according to findings recently presented at the American College of Obstetrics and Gynecology Annual Clinical and Scientific Meeting.

“It is the job of all women's health providers to ensure that women get regular, guideline-based cervical cancer screening with Pap smears or co-testing depending on her age,” Daniel Terk, MD, from the department of obstetrics and gynecology at University of Rochester’s School of Medicine and Dentistry, told Healio Family Medicine in an interview. “We should also be encouraging our patients to have their children vaccinated against HPV. Family medicine doctors are in a unique place to do this as they care not just for the mothers, but also their children.”

Daniel Terk

Because limited data exist on how vaccination impacts patient behavior, researchers evaluated whether adherence to cervical cancer screening recommendations is affected by HPV vaccination. They conducted a retrospective chart review using billing data for cervical cytology and HPV vaccination from 2006, the year the HPV vaccine was released, to 2010, the last year of the annual cervical cytology recommendation. They included participants based on birth year, enrolling those who were old enough to obtain cervical cancer screening and young enough to receive the HPV vaccine. To examine adherence to cervical cancer screening, they used the ratio of appropriately timed Pap smears to all Pap smears during the study period.

Of the 943 participants included in the study, 593 were unvaccinated. The results showed that adherence to screening was unchanged by overall vaccination status. After comparing adherence before and after vaccination for 140 women vaccinated mid-study, Terk and colleagues found that these women were significantly less likely to adhere to screening after vaccination (OR = 0.19; 95% CI, 0.08-0.49).

These findings, Terk told Healio Family Medicine, showed that there were possible unintended consequences of HPV vaccination.

“However, it is unclear if this is still a risk because girls are now getting vaccinated at a much younger age and, unlike in my study, women are not making a distinct decision to seek out vaccination,” Terk said. “This earlier age at vaccination, along with changes in Pap smear guidelines, makes the study somewhat less applicable to today patients.”

“The take home message is simply that everyone (male and female) between the ages of 9 and 26 should get the HPV vaccine. All women over the age of 21 need regular Pap smears, and perhaps this need should be emphasized in vaccinated women,” Terk said. – by Savannah Demko

Disclosure: Terk reports no relevant financial disclosures.