Cervical cancer is a unique disease from a preventive perspective, as it is the second most common cancer globally and yet is highly preventable.
Advancing Cervical Cancer Eradication Strategies
Cytological screening has decreased the risk for cervical cancer in Sweden but the incidence is no longer falling and the prevalence of its causative agent human papillomavirus (HPV) is increasing in the population. New prevention tools based on HPV detection and vaccination have the potential to reverse this scenario. Yet, these tools have not been fully implemented. Ensuring their proper implementation and accessibility should be a top priority for public health research.
From a strategic viewpoint, with remarkable population-based registers and biobanks, Sweden has the unique opportunity to take the international lead in the evaluation and implementation of optimized cervical cancer prevention. This project is funded by Stiftelsen för Strategisk Forskning/Swedish Foundation for Strategic Research with the aim to build a National Cervical Cancer Analysis Database and Biobank by a focused combination of data and samples from i) the National Quality Register for Cervical Screening, encompassing almost 40 years of screening experience in Sweden, ii) the Swedish HPV Vaccination Register, iii) other population-based health data registers, iv) HPV testing databases, and v) biobanks. This will create a world-class resource that can be exploited for state-of-the-art public health research including active implementation and evaluation of new preventive strategies.
Main financing: Swedish Foundation for Strategic Research
Studies that are part of ACCES
Population-based study on HPV vaccine effectiveness against condyloma and cervical cancer
Human papilloma virus (HPV) vaccine has been available since 2006. In Sweden the vaccine was subsidized for girls age 13-17 until 2012 when HPV-vaccination became part of the school-vaccination program. In addition to protection against cervical cancer, one of the two existing HPV vaccines also offers protection against genital warts. The effectiveness of the HPV vaccine against genital warts has been studied in the Swedish population during the five first years after its introduction. However, genital warts are not caused by the same HPV types as those causing cervical cancer. Therefore, there is a need to also investigate vaccine effectiveness on other HPV related outcomes such as precancerous lesions of the cervix. Further, the continuous evaluation on vaccine safety is important to ensure an acceptable balance between benefits and risks with HPV vaccines and to maintain public trust in the vaccine program.
These studies have both clinical and public health relevance, as they lay the scientific basis for guidelines, recommendations and clinical practice for HPV vaccination.
By using Swedish nationwide health care registers that can be linked on an individual level we are:
- Investigating HPV vaccine effectiveness on HPV related high grade cervical lesions;
- Studying HPV vaccine effectiveness on HPV related high grade cervical lesions by vaccine dose level and timing of doses;
- Further follow-up on HPV vaccine effectiveness on genital warts by vaccine dose level and timing of doses
Association of varying number of doses of quadrivalent human papillomavirus vaccine with incidence of condyloma.
Herweijer E, Leval A, Ploner A, Eloranta S, Simard J, Dillner J, et al
JAMA 2014 Feb;311(6):597-603
Quadrivalent human papillomavirus vaccine effectiveness: a Swedish national cohort study.
Leval A, Herweijer E, Ploner A, Eloranta S, Fridman Simard J, Dillner J, et al
J. Natl. Cancer Inst. 2013 Apr;105(7):469-74
Incidence of genital warts in Sweden before and after quadrivalent human papillomavirus vaccine availability.
Leval A, Herweijer E, Arnheim-Dahlström L, Walum H, Frans E, Sparén P, et al
J. Infect. Dis. 2012 Sep;206(6):860-6
Safety follow-up of HPV vaccination in the Swedish and Danish population
We have together with Statens Serum Institut in Denmark provided population-based data on potential adverse events following HPV vaccination in Sweden and Denmark, in those women who were vaccinated between 2006 and 2010. We are continuing our follow-up on safety of the HPV vaccine in the Danish and Swedish populations.
Autoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study.
Arnheim-Dahlström L, Pasternak B, Svanström H, Sparén P, Hviid A
BMJ 2013 Oct;347():f5906