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HPV vaccine impact in Australian women: ready for an HPV-based screening program

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In 2017, Australia is moving to a new state-of-the-art, evidence-based cervical screening program using primary human papillomavirus (HPV) DNA testing for all women, whether they have received HPV vaccination or not. Commencing HPV screening at 25 years of age is only possible in the context of a decrease in high-risk HPV prevalence in young women. This is because in an unvaccinated population of young women, infection with HPV (particularly the most oncogenic types, HPV 16 and 18) is common and would result in over-referral of women who test positive for HPV 16 or 18 to colposcopy for infections never destined to persist or cause disease. Since the implementation of the quadrivalent HPV vaccination program in Australia between 2007 and 2009, when over half of all women aged 12–26 years were fully vaccinated, the prevalence of HPV 16 and 18 in young women has declined dramatically.1,2

Using Victorian Cervical Cytology Registry data, including those from 2014, we present for the first time evidence that strongly suggests that the impact of the vaccination program on histologically confirmed cervical pre-cancerous lesions now extends to women aged 25–29 years (a 17% decline in the past 2 years from 18.8/1000 to 15.6/1000 [χ2 = 18.6; P < 0.0001]) (Box). We also note the first…