Source: Pedersen K, Di Silvestre J, Sy S, et al. Optimizing cervical cancer screening by age at vaccination for human papillomavirus: health and resource implications. Ann Intern Med. 2026;179 (4): 497-505; doi: 10. 7326/ANNALS-25-03192. Investigators from multiple institutions conducted a cost-effectiveness analysis to determine optimal cervical cancer (CC) screening strategies in women who had been immunized with human papillomavirus (HPV) vaccine at different ages. For their models, they assumed that CC screening would be HPV-based, with cytology screening and/or colposcopy for women with positive tests. Hypothetical cohorts of women who had been vaccinated at 12, 13–15, 16–18, 19–21, 22–24, 25–27, and 28–30 years of age, and with either bivalent (2vHPV) or nonavalent (9vHPV) vaccine, were developed. Models with CC screening at intervals of 5, 7, 10, 15, 20, and 25 years assessed. Costs of screening and resultant testing were estimated with each strategy, as were health outcomes (eg, cancer), and percentage of CC prevented. The primary outcome of each model was cost per quality adjusted life year (QALY) gained. Models for which the cost per QALY gained were <55, 000 were considered to be cost-effective. To assess harms of screening, the number of colposcopy referrals per additional CC case averted with the different strategies also was calculated. Using a benchmark of 47. 5 colposcopy referrals per CC case averted in unvaccinated women, screening strategies in vaccinated women that matched this benchmark were identified. Regardless of the age of HPV vaccination, extending the interval of HPV testing beyond the currently recommended interval of every 5 years resulted in decreased cost per QALY gained. For example, for women who received 9vPHV vaccine at 16–18 years old, beginning HPV testing at age 25 and continuing testing every 5 years until age 69 prevented 97% of cases of CC but led to 290 colposcopies per 1, 000 women and cost 802, 250 per QALY gained. If the interval between HPV test was extended to every 20 years, 92% of cases of CC were prevented, there were 180 colposcopies per 1, 000 women, and the cost per QALY gained was 62, 980. For women who had received 9vHPV vaccine when they were 12 or 13–15 years old, screening beginning at 35 years of age and repeated 25 years later met the <55, 000 per QALY gained threshold. Even for women who received either 2vHPV or 9vHPV vaccine when they were 28–30 years old, increasing the interval for HPV screening from 5 to 10 years was cost-effective. For women vaccinated with 9vHPV when they were 12 years old, HPV screening every 5 years led to 590 colposcopies per case of CC averted. By extending the interval between screenings to 15 years, the ratio dropped below the benchmark ratio of 47. 5. The authors conclude that less frequent HPV screening for CC would be cost-effective in women who were vaccinated against HPV when they were adolescents or young adults. Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. In the 1960s, cervical cancer was the leading cause of cancer death among women. 1 With the initiation of the Papanicolaou (Pap) test in 1945, mortality decreased by 70%. 1 For many years, an annual Pap smear was recommended for early detection. 1 In the 1970s, the association between HPV and cervical cancer was well-described. 2 Approximately 90% of sexually active people are infected by HPV by 30 years of age. 2 In 2006, the HPV vaccine was introduced after large clinical trials demonstrated that the vaccine prevented nearly 100% of HPV infections. 3The success of the HPV vaccine already has lengthened the screening interval for cervical cancer. Presently, the American Cancer Society recommends women between 25–65 receive HPV-based screening every 5 years. 4 Since the first large cohort of women are now eligible to be screened, what should the optimal interval be, especially given the efficacy of the vaccine? The current authors conclude that a screening interval of 10–25 years would be appropriate depending upon the age when receiving the vaccine. The younger one receives the vaccine, the later and less frequently screening is necessary. This strategy reduces the number of lifetime tests and unnecessary colposcopy procedures, with minimal reduction in missed cases. The current authors thus propose a paradigm shift toward ever-increasing screening intervals, based on individualized risk. In an era of vaccine hesitancy, providers need to deftly encourage patients to adopt the HPV vaccine. The screening interval for CC may be extended from 5 years to 10–25 years, depending on the age at which the HPV vaccine was received. We would suggest that antibiotic-associated altered maternal vaginal flora, coupled with medical interventions in increasingly low birth weight and premature infants, contributed to the observed increase in EOS neonatal gram-negative infections.
A Mon, study studied this question.