Norway’s high HPV vaccination rate could help reduce testing, study suggests
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Suppose you live in a country with extremely high HPV vaccination coverage and a uniform cervical cancer screening program. A new study suggests that depending on when you received your shots, you may only need a few shots in your lifetime.
In this case, that country is Norway. Using a mathematical model, researchers found that Norwegian women vaccinated between the ages of 12 and 24 would only need screening once every 15 to 25 years. For women who received the HPV vaccine between the ages of 25 and 30, ten years between screenings would be sufficient, researchers report February 3 in Annals of internal medicine.
The HPV vaccine “is a cancer vaccine,” says Kimberly Levinson, director of Johns Hopkins Gynecologic Oncology at Greater Baltimore Medical Center, who was not part of the research team. There is already excellent effectiveness data for this vaccine and the new research shows “the potential that exists if we can actually get people vaccinated in a timely manner,” Levinson says.
The human papillomavirus is sexually transmitted and almost everyone will become infected with HPV after becoming sexually active. Most of the time, the immune system handles the infection. But if infection persists with one of the high-risk HPV types, it can lead to cancer. HPV is responsible for, among other things, cancers of the cervix, throat, penis and anus. In Norway, girls and boys receive the HPV vaccine at age 12. In the United States, the vaccine is recommended for girls and boys ages 11 to 12. There is a catch-up vaccination schedule for certain older ages.
In 2021, HPV vaccine coverage in Norway was more than 90 percent. HPV testing, recommended every five years, is the main screening strategy in Norway, where health care is universal. Studies have shown that HPV test does a better job as Pap tests to detect abnormal cells before they become cancerous. Norway’s approach to cervical cancer has allowed them to eliminate cancer by 2039, another modeling study suggests.
On the other hand, vaccination against HPV coverage is about 57 percent for 13 to 15 year olds in the United States, from 2023. And screening, with HPV test or with Pap tests, it’s not as consistent. About a quarter of women aged 21 to 65 were behind in cervical cancer screening in 2023. Cervical cancer screening rates have fallen during the COVID-19 pandemic and I haven’t bounced back yet at 2019 levels. And this is in the context of a steady decline in this screening that has taken place over the last two decades or so.
Levinson says it is important to consider the new study in the context of conditions in Norway, which include a very high vaccination rate and a much stricter and uniform testing program. “This is different from the situation we find ourselves in in the United States.”
Relying on both vaccination and screening for cervical cancer prevention will continue to be important in the United States, Levinson says. “We want to promote HPV vaccination because it is safe and effective,” she says, “and at the same time, we don’t want to miss the opportunity to screen women.”
