1. Nalley, Catlin

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A recent meta-analysis found that the addition of the HPV vaccine to standard treatments reduces the risk of recurrent high-grade cervical dysplasia (CIN2+), the abnormal growth of cells on the cervix that can develop into cancer.

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The study demonstrated that the risk of recurrent CIN2+ was lowered by almost two-thirds among patients who received the HPV vaccination, according to findings released by the Society of Gynecologic Oncology (Abstract 120).


Study Details

Data from six studies-published between January 1, 1990, and January 1, 2019-was analyzed, comparing women who received the HPV vaccination plus surgical excision to those who underwent surgical management alone. Among the 2,984 women included in the studies, 1,360 (45.6%) received adjuvant HPV vaccination and surgical excision, while 1,624 (54.4%) had placebo or surgical excision alone for CIN2+.


The analysis found that recurrence of CIN2+ occurred within 6-48 months in 99 women (3.3%) overall, and the researchers reported it was significantly lower for patients who were vaccinated versus those who were not.


"The most important finding is the reduction in the risk of recurrent high-grade dysplasia of approximately 64 percent, from 5.5 percent in unvaccinated women to 1.9 percent in women who were vaccinated," noted study senior author Kim Levinson, MD, MPH, Assistant Professor and Director of Johns Hopkins Gynecologic Oncology at Greater Baltimore Medical Center.


Additionally, the researchers reported that the risk of CIN1+ was also significantly lower with adjuvant HPV vaccination. CIN1+ occurred in 86 of 1,360 vaccinated women (6.3%) compared to 157 of 1,624 unvaccinated women (9.7%).


"Furthermore, when evaluating dysplasias that are related to the most oncogenic HPV types (16,18), there is a reduction in the risk of HPV 16,18 related lesions of approximately 59 percent, from 2.0 percent to 0.9 percent," Levinson explained.


Four studies evaluated the recurrence of lesions in HPV strains 16/18. Thirty-five women developed recurrent HPV 16/18 CIN2+, nine of whom received the adjuvant vaccination and 26 who did not, the study authors reported.


"Adjuvant HPV vaccination after surgical excision for CIN2+ is associated with a significant reduction in the risk of both recurrent high-grade and low-grade cervical dysplasia," the study authors wrote. "The risk of recurrent lesions caused by the most oncogenic strains (HPV 16/18) is also significantly reduced with adjuvant HPV vaccination. HPV vaccination should therefore be considered for adjuvant treatment to surgery in patients undergoing surgical excision for CIN2+."


There are currently two ongoing large, randomized controlled trials underway that should help better elucidate the benefit of adjuvant HPV vaccine in this setting, according to Levinson.


Clinical Implications

These findings demonstrate the importance of the HPV vaccination and its many potential benefits.


"These findings suggest that there is a significant association with HPV vaccination at the time of surgical resection for dysplasia and a reduction in the risk of recurrence," explained Levinson. "Recurrent cervical dysplasia is concerning for multiple reasons, first and foremost because of concerns for progression to an invasive cancer.


"This also may have significant clinical benefit as women with recurrent disease require multiple examinations and procedures, many of which could be prevented or decreased with decreases in the risk for recurrent disease," she continued. "Furthermore, most women affected by dysplasia are young with concerns for fertility preservation. Multiple surgical resections-which may be required for recurrent dysplasia-can increase pregnancy risks."


Levinson also emphasized that there are a number of important considerations regarding the HPV vaccination, including the extensive safety data that supports the use of this vaccine.


"For prevention purposes, this vaccine prevents cancer and should be utilized extensively and early to prevent HPV disease and HPV-related cancers," she said. "Vaccination rates are still too low, and we continue to see these preventable diseases killing women and men.


"It is important that coverage for vaccination keep up with the data with regards to the benefit of vaccine for various patients," Levinson concluded. "It is critical that all women, across all demographics, be able to have access and coverage for the vaccine when indicated and supported by data."


Catlin Nalley is a contributing writer.