Introduction/Background Women with treatment of HSIL of the cervix have an increased risk for subsequent HPV related diseases. Developed for primary prevention, the HPV vaccines have demonstrated disease reduction in females and males after treatment of HPV related disease. We investigated the influence of HPV vaccination before or after conization on the incidence of recurrent HSIL of the cervix.
Methodology A PubMed search provided five appropriate studies addressing the incidence of recurrent HSIL (CIN 2+) after conization in vaccinated or unvaccinated women. Three studies were post-hoc analyses of large prospective randomized trials. One study was retrospective and another study was prospective but not randomized. Data of 3202 women with conization were included into this meta-analysis.
Results In the HPV vaccinated cohorts, the risk for recurrent disease was reduced by two thirds (RR 0.34 [0.21, 0.56]). Four of five studies demonstrated recurrent disease reduction of ≥ 65%, the only negative study was underpowered to address this issue.
Conclusion HPV vaccination before or after conization appears to have a significant effect on recurrent disease. In addition, a reduction of subsequent vulvovaginal disease after treatment has been demonstrated. A randomized controlled trial has already been started in the Netherlands. A cost-effectiveness analysis is missing to this date.
Disclosure VP: non to declare RS: travel expenses: Amgen, Roche, Pharma Mar (not related to this work) SP: lecture fee: MSD (not related to this work) RR: none to declare EJ: Research grant: MSD Advisory board fee and lecture fee: MSD, Roche.
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