Objective: To compare cervical screening rates for women vaccinated with a quadrivalent human papillomavirus (HPV) vaccine with those for unvaccinated women, to address concerns that vaccinated women may not be participating in cervical screening.
Design, setting and participants: Cross-sectional analysis of linked data from the Victorian Cervical Cytology Registry and the National HPV Vaccination Program Register for 20–29-year-old women in Victoria, Australia, for the period 1 January 2009 to 31 December 2011.
Main outcome measures: Screening participation rates for vaccinated and unvaccinated women.
Results: Participation in cervical screening during the 2-year period 2010–2011 was significantly lower in 20–24-year-old vaccinated women compared with unvaccinated women of the same age (37.6% v 47.7%, a 10.1 percentage point difference [95% CI, 9.7–10.6]; P < 0.001) and significantly lower in 25–29-year-old vaccinated women compared with unvaccinated women of the same age (45.2% v 58.7%, a 13.5 percentage point difference [95% CI, 13.1%–13.9%]; P < 0.001). Similar results were observed for participation during the 3-year period 2009–2011.
Conclusions: Despite education messages provided to young women, our results suggest that vaccinated women are being screened at lower rates than unvaccinated women in Australia. While some degree of undermatching of women in the study may have occurred, this cannot wholly explain our findings. Effective implementation of Individual Healthcare Identifiers to health records, including registry records, is needed to prevent potential undermatching of individuals in future linkage studies. In the meantime, efforts to increase participation in cervical screening by vaccinated women are needed.
- 1. Australian Institute of Health and Welfare. Cervical screening in Australia 2010–2011. Canberra: AIHW, 2013. (AIHW Cat. No. CAN 72; Cancer Series No. 76.) http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129543399 (accessed Jan 2014).
- 2. Brotherton JM. How much cervical cancer in Australia is vaccine preventable? A meta-analysis. Vaccine 2008; 26: 250-256.
- 3. Victorian Cervical Cytology Registry. Statistical report 2012. http://www.vccr.org/downloads/stat_report_2012.pdf (accessed Feb 2014).
- 4. Gertig DM, Brotherton JM, Saville M. Measuring human papillomavirus (HPV) vaccination coverage and the role of the National HPV Vaccination Program Register, Australia. Sex Health 2011; 8: 171-178.
- 5. Brotherton J, Gertig D, Chappell G, et al. Catching up with the catch-up: HPV vaccination coverage data for Australian women aged 18-26 years from the National HPV Vaccination Program Register. Commun Dis Intell Q Rep 2011; 35: 197-201.
- 6. Brotherton JM, Liu B, Donovan B, et al. Human papillomavirus (HPV) vaccination coverage in young Australian women is higher than previously estimated: independent estimates from a nationally representative mobile phone survey. Vaccine 2014; 32: 592-597.
- 7. Brotherton JM, Leask J, Jackson C, et al. National survey of general practitioners' experience of delivering the National Human Papillomavirus Vaccination Program. Sex Health 2010; 7: 291-298.
- 8. Mullins R, Coomber K, Broun K, Wakefield M. Promoting cervical screening after introduction of the human papillomavirus vaccine: the effect of repeated mass media campaigns. J Med Screen 2013; 20: 27-32.
- 9. Gertig DM, Brotherton JM, Budd AC, et al. Impact of a population-based HPV vaccination program on cervical abnormalities: a data linkage study. BMC Med 2013; 11: 227.
- 10. Brotherton JM, Mullins RM. Will vaccinated women attend cervical screening? A population based survey of human papillomavirus vaccination and cervical screening among young women in Victoria, Australia. Cancer Epidemiol 2012; 36: 298-302.
- 11. National E-Health Transition Authority. Healthcare identifiers (HI). http://www.nehta.gov.au/our-work/healthcare-identifiers-hi (accessed Jan 2014).
- 12. Department of Transport, Planning and Local Infrastructure, State Government of Victoria. Internal migration in Victoria. http://www.dpcd.vic.gov.au/home/publications-and-research/urban-and-regional-research/census-2011/internal-migration-in-victoria (accessed Aug 2014).
- 13. Australian Bureau of Statistics. Marriages and divorces, Australia, 2011. (ABS Cat. No. 3310.0.) http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3310.0Main+Features12011?OpenDocument (accessed Jan 2014).
- 14. Barbaro B, Brotherton JML, Gertig DM. Human papillomavirus vaccination and cervical cancer screening by socioeconomic status, Victoria [letter]. Med J Aust 2012; 196: 445. <MJA full text>
- 15. National Cervical Screening Program. National Cervical Screening Program Renewal. http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/ncsp-renewal (accessed Aug 2014).
- 16. Canfell K, Sitas F, Beral V. Cervical cancer in Australia and the United Kingdom: comparison of screening policy and uptake, and cancer incidence and mortality. Med J Aust 2006; 185: 482-486. <MJA full text>
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.