HPV vaccination and surgical treatment of cervical lesions may reduce risk of further disease

Vaccination against human papillomavirus (HPV) in women during surgery for cervical precancer may reduce the risk of disease recurrence as well as other HPV-related diseases, a study suggests Today in the British Medical Journal .

However, the researchers stressed that the quality of the evidence ranged from very low to moderate and that further high-quality trials are These results need to be confirmed.

HPV vaccination is very effective in preventing the development of cervical precancerous lesions (cervical intraepithelial neoplasia or CIN) .

Many countries, including the UK, offer HPV vaccination for girls and boys around age 12 or 13 to protect They are protected from cervical cancer and other related cancers later in life.

CIN is divided into three levels: CIN1, 2 or 3.

Women treated for high-grade CIN have a lifetime residual high risk of cervical cancer and other malignancies associated with HPV infection Oncology, some studies suggest that giving a prophylactic HPV vaccine at the same time as treatment for CIN may help reduce the risk in these women.

To explore this further, researchers analyzed the results of 18 studies evaluating HPV vaccines The effect of vaccination on the risk of HPV infection or the risk of recurrence of HPV infection-related lesions after local surgical treatment.

These included two randomised controlled trials (RCTs), 12 observational studies and four One RCT post hoc analysis (when researchers re-examined data after the trial ended).

Both trials were classified as low risk of bias, whereas in observational studies and post hoc analyses, bias The risk is 7 moderate, 7 severe, and 2 severe. The mean follow-up time was 36 months.

Results show the risk of recurrence of high-grade preinvasive lesions in vaccinated individuals compared with unvaccinated individuals (CIN2+) decreased by 57%.

Effect When assessing CIN2+ recurrence risk for disease associated with two high-risk HPV types (HPV16 and HPV18), estimated Values ​​were even higher (74% relative reduction), and these two high-risk HPV types are responsible for the majority of cervical cancers.

However, the researchers noted that these effects are not yet known due to scarcity of data and an overall moderate to high risk of bias clear.

Vaccinated patients also have a reduced risk of higher-grade CIN3 recurrence, but again, quality of evidence exists High uncertainty.

Evidence for the benefit of HPV vaccination is also lacking in the recurrence of vulvar, vaginal, or anal lesions and genital warts.

The researchers acknowledge some limitations. For example, most studies were observational, of low to moderate quality, with relatively short follow-up and were unable to assess long-term effects.

In addition, most studies did not provide the mean age of participants, and in many studies no controls for factors such as smoking ( associated with a higher risk of recurrence).

However, they stated that they used strict study inclusion criteria and a rigorous and systematic approach to study quality and risk of bias The evaluation shows that the results are strong.

Therefore, they concluded that HPV vaccination may reduce the risk of CIN recurrence, especially in relation to HPV16 time or HPV18, in women treated with local excision, although the quality of the evidence suggests the data are inconclusive.

Large-scale, high-quality randomized controlled trials are needed to determine the risk of HPV vaccination in women, they added. effectiveness and cost levels.