HPV shots reduce need for cancer screenings

Hello Health Rounds readers! Today we feature a Norwegian study that found women who got an HPV vaccine, such as Merck's Gardasil, can significantly cut back on screenings for cervical cancer. We also report on a study that found lower survival rates in cancer patients diagnosed in the first years of the COVID-19 pandemic.

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Women vaccinated against the human papillomavirus can safely skip many of the cervical cancer screenings that are typically recommended every three to five years, a new study from Norway suggests.

Women vaccinated against HPV between ages 12 and 24 need screening every 15 to 25 years, meaning they would be tested only two or three times during their lifetime, researchers reported in Annals of Internal Medicine.

Because the vaccine is most effective when given at younger ages, women vaccinated between ages 19 and 21 should be screened every 20 years starting at age 25, and those vaccinated between 25 and 30 should be screened every 10 years.

Screening can stop after age 65 for most women, guidelines say.

The researchers used government health data and computer modeling to estimate the long-term health and economic outcomes of alternative screening strategies after immunization with either a vaccine targeting two types of HPV or one targeting nine types of HPV, such as Merck's Gardasil 9.

The success of these recommendations depends on having the kind of accurate vaccination records and coordinated screening systems available in Norway, they said.

In countries like the U.S., where there are no nationwide vaccination registries or organized screening programs, it could be challenging for women to remember their vaccination age and for doctors to stay up to date with the detailed, often individually adjusted recommendations, according to an editorial published with the study. Still, the study does show that cervical cancer screening can be safely reduced in vaccinated women without compromising prevention, Dr. Nicolas Wentzensen of the U.S. National Cancer Institute wrote in the editorial.

Over time, as more women are vaccinated and herd immunity becomes more likely, increased start ages and longer intervals can be considered for the entire population and the optimal strategies for vaccinated and unvaccinated individuals "will ultimately converge," Wentzensen said.

Separately, researchers from China reported in The BMJ that testing menstrual blood for HPV could become a "robust alternative or replacement" for current cervical cancer screening methods.

Among 3,068 participants, the odds that a negative test result truly reflected the absence of disease and that a positive test result truly reflected a need for further work-up were equivalent with the menstrual blood analysis and traditional HPV testing in clinics, according to the report.

U.S. patients diagnosed with cancer early in the COVID-19 pandemic experienced worse survival during the first year after their diagnosis than those diagnosed in earlier years, researchers reported in JAMA Oncology.

The study of more than 1 million patients diagnosed with early- or late-stage cancer in 2020 and 2021 found they experienced an estimated 17,390 more deaths within one year of diagnosis than expected, compared with those diagnosed from 2015 to 2019.

Compared with pre-pandemic trends, survival at one year was 0.44 percentage points lower in 2020 and 0.37 percentage points lower in 2021 for people with early-stage diagnoses. It was 0.34 and 0.20 percentage points lower in 2020 and 2021, respectively, for patients diagnosed with late-stage cancers in those years.

Survival reductions occurred among all population subgroups, with a greater impact on individuals aged 65 years or older.

The results suggest "substantial harms associated with cancer care disruptions during the first two years of the COVID-19 pandemic," the authors said.

"Continued surveillance is needed to assess whether additional changes in survival outcomes extended further into and after the pandemic," they added.

This newsletter was edited by Bill Berkrot; additional reporting by Shawana Alleyne-Morris.