Projected impact of HPV vaccination and primary HPV screening on cervical adenocarcinoma: Example from Australia

- Impact of HPV screening & vaccination on adenocarcinoma has not yet been estimated.
- Incidence rates will drop by >50% in Australia due to HPV screening & vaccination.
- Majority of impact in women aged <50 before 2040 is from HPV vaccination.
- In women aged 50+ virtually only impact before 2040 is from HPV screening.
- Screening impact in women 50+ is comparable to vaccination impact in women <50.

Cytology-based cervical screening appears to have had a limited effect on the incidence of adenocarcinoma, however HPV vaccination and HPV-based screening will likely play a role in reducing future burden. Using Australia as an example, we estimated the future burden (2015-2040) of adenocarcinoma in the absence of other interventions; and the impact of HPV vaccination (introduced 2007) and HPV-based screening (commencing 2017).Future burden was estimated considering underlying trends in adenocarcinoma, using national data (1982-2010). The relative reduction in adenocarcinoma due to HPV vaccination and HPV-based screening was derived from observed clinical data.Adenocarcinoma incidence rates have been increasing since the early-mid 2000s (average annual increases from 3.0%(25-49 years) −8.1%(20-24 years)). If these trends continue, rates would increase from 1.4 to 2.4/100,000 in <50 years and from 2.2 to 4.4/100,000 in 50+ years by 2040. Taking into account coverage, HPV vaccination will reduce 2040 incidence by 36-39%, mainly in women <50 years (61% reduction). Taking into account uncertainties in trends and screening effectiveness, HPV-based screening will reduce incidence by an additional 19-43%, mainly in women 50+ years (additional 30-68% reduction). Together, these interventions will reduce incidence by 55-81%.