Cervical screening rates for women vaccinated against human papillomavirus

Alison C Budd, Julia M L Brotherton, Dorota M Gertig, Theresa Chau, Kelly T Drennan and Marion Saville
Med J Aust 2014; 201 (5): 279-282. || doi: 10.5694/mja14.00021


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]; < 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%]; < 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.

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  • Alison C Budd1
  • Julia M L Brotherton2,3
  • Dorota M Gertig2,3
  • Theresa Chau1
  • Kelly T Drennan2
  • Marion Saville2

  • 1 Cancer and Screening Unit, Australian Institute of Health and Welfare, Canberra, ACT.
  • 2 Victorian Cytology Service, Melbourne, VIC.
  • 3 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC.



We thank Genevieve Chappell, Michael Malloy, Cathryn May, Karen Winch and the information technology team at the Victorian Cytology Service (VCS) for assisting with data extraction and testing, and staff at the Data Linkage Unit at the AIHW for conducting the data linkage. The VCCR is fully funded by the Victorian Department of Health and operated by the VCS. The NHVPR is owned by the Australian Government Department of Health and operated by the VCS. This study was funded by the VCS. We had full access to all de-identified VCCR and NHVPR data.

Competing interests:

Julia Brotherton, Dorota Gertig and Marion Saville were investigators on an Australian Research Council linkage grant on which bioCSL was a partner organisation. Julia Brotherton has been an investigator on investigator-initiated epidemiological research studies which have received partial and unrestricted grants from bioCSL and Merck but has received no personal financial benefits from these grants.

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