Potential effects of decreased cervical cancer screening participation after HPV vaccination: an example from the U.S

A concern with widespread implementation of HPV vaccination programs is that women may mistakenly decide that they do not need to be screened any longer, and thus be less likely to participate in cervical cancer screening, because they view themselves to be at low-risk of developing cervical cancer. We hypothesized that non-participation in screening among vaccinated young women in the 5 years following vaccination may result in missed CIN 2-3 cases that could progress to cancer. For instance, if 50% fewer women 26-30 years old, who were vaccinated, participate in screening in the United States over a 5 year time horizon, there would be approximately 4 women (per 1000) with missed CIN 2-3. On the other hand, non-participation will reduce the number of false-positive screening test results, as non-participation would avoid approximately 27 false-positive test results, with a decrease in follow-up procedures and costs. These results highlight the importance of educating women to ensure continued screening, as well as the need to consider new approaches to screening in the era of vaccination.