Only Three Pap Tests May Be Needed for HPV Vaccinated Women

Merck Gardasil 9 vaccine immunizes against nine genotypes of HPV known to cause cervical cancer

Women may only need three cervical screens in their lifetime if they have been vaccinated with the human papillomavirus (HPV) vaccine, according to a new study

This cancer research team from Queen Mary University of London (QMUL), found that three screens at 30, 40 and 55 years old would offer the same benefit to vaccinated women, as the 12 lifetime screens currently offered in England.

Since 2008, the HPV vaccine has been offered to school girls aged 11-13 across the UK. This group is now reaching the age for their first cervical screening invitation.

This new research shows that these women can still be effectively protected from cervical cancer with fewer screens, which could also save the NHS resources.

"With all of the voices screaming about the dangers of vaccines to the uninformed, it is refreshing to see validation of a vaccine initiative.  HPV vaccines are not only reducing the risks of cancer for individuals, they are also reducing costs to our health care systems.  This study strengthens my recommendation of the HPV vaccine to eligible patients," said Chris Felton PharmD, MTM Clinical Pharmacist with Brookshire Grocery Company.

To benchmark cost-benefits of screening for vaccinated women, these researchers evaluated the proportion of cancers prevented per additional screen of current cytology and likely HPV screening scenarios in unvaccinated women.

This means that cervical samples are tested for HPV, but only checked for abnormal cells if the virus is found. The current test checks for abnormalities first, which is less efficient.

This research found:

  • HPV16/18/31/33/45/52/58-vaccinated women, two lifetime screens are supported.
  • HPV16/18-vaccinated women require three lifetime screens,
  • HPV16/18/31/33/45/52/58-vaccinated women require two lifetime screens,
  • unvaccinated women require seven lifetime screens

This new programme called HPV primary testing is set to be introduced in England by December 2019.

Scotland and Wales are also preparing their own plans to introduce this new HPV test.

Professor Peter Sasieni, Cancer Research UK's screening expert and lead author based at QMUL, said, "These women are far less likely to develop cervical cancer so they don't need such stringent routine checking as those at a higher risk. This decision would free up resources for where they are needed most.”

“The change in the screening system is a unique opportunity to reassess how often women are invited for cervical screens during their lifetimes," said Sasieni.

The American College of Gynecology recommends that women aged 21–29 years should have a Pap test alone every 3 years. Women aged 30–65 years should have a Pap test and an HPV test (co-testing) every 5 years (preferred).

Although rates have improved in the U.S., only 60 percent of teens 13-to-17-years-old had received one or more doses of the HPV vaccine in 2016, the Centers for Disease Control and Prevention (CDC) reported.

The CDC currently recommends two doses of the HPV vaccine for teens younger than 15 and three doses for those who start the vaccine series at ages 15 through 26.

The Gardasil 9 vaccine immunizes against nine genotypes of HPV known to cause cervical cancer, as well as vulvar, vaginal and anal cancers and genital warts caused by HPV.

The CDC Vaccine Price List provides the private sector vaccine prices for general information.

Most pharmacies offer vaccination services, including HPV.

HPV vaccine discounts can be found here.

This research was funded by Cancer Research UK . Grant Number: A16892, and Engineering and Physical Sciences Research Council . Grant Number: EP/K000128/1.  No conflicts of interest were disclosed.