Cancer Research Division, Cancer Council NSW, Sydney, Australia.
Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia.
Vaccine. 2018 Oct 8;36(42):6314-6324. doi: 10.1016/j.vaccine.2018.08.063. Epub 2018 Sep 14.
Cervical cancer rates are over twice as high, and screening coverage is lower, in Māori women compared to other women in New Zealand, whereas uptake of HPV vaccine is higher in Maori females. We aimed to assess the impact of HPV vaccination and the proposed transition to 5-yearly primary HPV screening in Māori and other women in New Zealand, at current participation levels; and additionally to investigate which improvements to participation in Māori females (in vaccination, screening, or surveillance for screening-defined higher-risk women) would have the greatest impact on cervical cancer incidence/mortality.
An established model of HPV vaccination and cervical screening in New Zealand was adapted to fit observed ethnicity-specific data. Ethnicity-specific models were used to estimate the long-term impact of vaccination and screening (vaccination coverage 63% vs 47%; five-year screening coverage 68% vs 81% in Maori vs European/Other women, respectively).
Shifting from cytology to HPV-based screening is predicted to reduce cervical cancer incidence by 17% (14%) in Maori (European/Other) women, respectively. The corresponding reductions due to vaccination and HPV-based screening combined were 58% (44%), but at current participation levels long-term incidence would remain almost twice as high in Māori women (6.1/100,000 compared to 3.1/100,00 in European/Other women). Among strategies we examined, the greatest impact came from high vaccine coverage and achieving higher attendance by Māori women under surveillance for screen-detected abnormalities.
Relative reductions in cervical cancer due to vaccination and HPV-based screening are predicted to be greater in Maori than in European/Other women. While these interventions have the potential to substantially reduce between-group differences, cervical cancer incidence would remain higher in Maori women. These findings highlight the importance of multiple approaches and the potential influence of factors beyond HPV prevention.
与新西兰其他女性相比，毛利女性的宫颈癌发病率高出两倍以上，筛查覆盖率较低，而毛利女性接种 HPV 疫苗的比例较高。我们旨在评估 HPV 疫苗接种和拟议的向 5 年一次的主要 HPV 筛查过渡对新西兰毛利女性和其他女性的影响，目前的参与水平；并进一步探讨在毛利女性中（在疫苗接种、筛查或筛查定义的高危女性监测方面）提高参与度将对宫颈癌发病率/死亡率产生最大影响。
对新西兰 HPV 疫苗接种和宫颈筛查的既定模型进行了调整，以适应观察到的特定种族数据。使用特定种族的模型来估计接种和筛查的长期影响（接种覆盖率分别为 63%和 47%；5 年筛查覆盖率分别为 68%和 81%，毛利女性与欧洲/其他女性）。
从细胞学筛查向 HPV 筛查的转变预计将使毛利女性（欧洲/其他女性）的宫颈癌发病率分别降低 17%（14%）。接种和 HPV 筛查联合的相应降低幅度为 58%（44%），但在当前的参与水平下，毛利女性的长期发病率仍将几乎高出两倍（6.1/100,000 与欧洲/其他女性的 3.1/100,00）。在我们研究的策略中，最大的影响来自高疫苗覆盖率和提高毛利女性在筛查检测到异常的监测中的参与度。
与接种和 HPV 筛查相关的宫颈癌相对减少预计在毛利女性中比在欧洲/其他女性中更大。虽然这些干预措施有可能大幅减少群体间的差异，但毛利女性的宫颈癌发病率仍将更高。这些发现强调了多种方法的重要性以及 HPV 预防以外的因素的潜在影响。
