Cervical cancer prevention is changing worldwide. The introduction of primary prevention [vaccination] and changes to screening protocols [HPV testing], raise several challenges for cervical screening programmes, most notably with regard to impact of vaccination on screening as it is currently organised. If vaccination affects women’s likelihood of screening participation, or the performance of screening and diagnostic tests, screening will become less effective. Monitoring the impact of vaccination on screening is, therefore, important.
In Ireland, a national school-based HPV vaccination programme began in 2010. As the vaccine only targets the main HPV types (16/18), it is important that all women, aged 25- 60, continue to have regular cervical smear tests. In 2018, the first set of women who received the vaccine through the school programme (women in the “catch-up” cohort, of whom 19,000 were fully vaccinated), will be eligible to attend for their first CervicalCheck smear.
By following this cohort, CERVIVA-Vax will generate, for the first time, Irish data relating to the early impact of HPV vaccination on cervical screening. CERVIVA-Vax will assess the prevalence of HPV, HPV genotype diversity, abnormal cytology, and histology outcomes in vaccinated girls compared to age-matched unvaccinated woman enrolled in the CERVIVA HPV Primary Screening Study. CERVIVA-Vax will generate, for the first time, HPV prevalence, HPV genotype and molecular biomarker [E6/E7 mRNA, p16ink4a/Ki-67, and methylation markers (CADM1, MAL, miR124)] data on vaccinated women. Finally CERVIVA-Vax will investigate the impact of vaccination on screening uptake.
Changes in screening uptake, HPV infections and detection of cervical abnormalities may have an adverse effect on how well screening works for individual women and the population. By investigating the early impact of HPV vaccination on screening in Ireland, CERVIVA-Vax will be able to inform CervicalCheck, and international screening programmes, of the best cervical screening approach for both vaccinated and unvaccinated women.
