Positive predictive value of cervical cancer screening results recommended for colposcopy by human papillomavirus vaccination status at 3 U.S. healthcare systems

Abstract

Purpose: The positive predictive value (PPV) of cervical cancer screening was projected to decrease in the era of human papillomavirus (HPV) vaccination.

Methods: We conducted a retrospective cohort study at three U.S. healthcare systems during 2010-2018. Females aged 21-38 years with an abnormal cervical cancer screening test result for which colposcopy was guideline-recommended were included. We estimated age-specific PPVs of cervical intraepithelial neoplasia grade 2 or more severe diagnosis (≥ CIN 2) in HPV-vaccinated and unvaccinated females.

Results: The age-specific PPV point estimates were lower in vaccinated versus unvaccinated females in each age group (21-24; 25-29; and 30-38 years), but the difference was statistically significant only among 25-29-year-olds (PPV = 16.4% [95% CI (confidence interval), 14.6-18.4%] and PPV = 19.8% [95% CI 18.5-21.1%], respectively). Among vaccinated 25-29-year-olds, the PPV was lower in those who received their first dose at ≤ 20 versus > 20 years of age (PPV = 12.1% [95% CI 9.5-15.2%] and PPV = 18.8% [95% CI 16.4-21.4%], respectively). Among all age groups combined, the PPV was lower in vaccinated versus unvaccinated females.

Conclusions: Our findings suggest that among females with a cervical test result recommended for colposcopy, the PPV for ≥ CIN2 was lower in those vaccinated versus unvaccinated, and was relatively lower in those vaccinated at younger ages. Future studies will have greater ability to estimate the impact of vaccination at the recommended age (9-12 years) on the PPV as more recent birth cohorts, who had greater vaccine uptake, age-in to screening eligibility.

Keywords: Cervical cancer; Cervical squamous intraepithelial neoplasia; Human papillomavirus vaccination; Positive predictive value; Screening.