Association between human papillomavirus vaccine uptake and cervical cancer screening in the Netherlands: Implications for future impact on prevention

Authors

  • Anneke Steens,

    1. Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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  • Cornelia C.H. Wielders,

    1. Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
    2. Pallas Health Research and Consultancy B.V., Rotterdam, The Netherlands
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  • Johannes A. Bogaards,

    1. Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
    2. Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
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  • Hendriek C. Boshuizen,

    1. Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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  • Sabine C. de Greeff,

    1. Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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  • Hester E. de Melker

    Corresponding author
    1. Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
    • National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
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    • Tel.: +31-30-247-3958, Fax: +31-30-274-4409


Abstract

Several countries recently added human papillomavirus (HPV) vaccination to cervical cancer screening in the effort to prevent cervical cancer. They include the Netherlands, where both programs are free. To estimate their combined future impact on cancer prevention, information is needed on the association between participation in vaccination now and in screening in the future and on what groups are at risk for nonparticipation. We studied the association between participation in screening by mothers and in vaccination by their daughters. Girls' vaccination status was matched by house-address with their mothers' screening participation. We estimated the effect on cancer incidence by means of computer simulation. We investigated risk groups for nonparticipation using multivariable multilevel logistic regression and calculated population-attributable fractions. Our results, based on 89% of girls invited for vaccination in 2009 (n = 337,368), show that vaccination status was significantly associated with mothers' screening participation (odds ratio: 1.54 [95% confidence interval: 1.51–1.57]). If a mother's screening is taken as proxy of a girl's future screening, only 13% of the girls will not participate in either program compared to 23% if screening alone is available. The positive association between vaccination and screening resulted in slightly lower model estimates of the impact of vaccination on cancer incidence, compared to estimates assuming no association. Girls with nonwestern ethnicities, with young mothers, who live in urban areas with low socioeconomic status, are at risk for nonparticipation. A significant part of potential nonscreeners may be reached through HPV vaccination. Estimates made before vaccination was introduced only slightly overestimated its impact on cervical cancer incidence.

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