Abstract：
OBJECTIVE: Around 70% of vaginal cancers and 40-50% of vulvar cancers are attributable to human papillomavirus (HPV). Globally the burden of these diseases is estimated to grow due to the increasing HPV prevalence and rapidly aging global population. We aimed to examine if HPV screening for cervical cancer has an additional beneficial effect in preventing vaginal and vulvar cancers. To assess this, we used long-term follow-up data from the Finnish randomized HPV screening trial.
METHODS: Between 2003 and 2008, over 236,000 women were individually randomized (1:1) to primary HPV or cytology screening in Southern Finland. We followed this cohort up to the year 2020. To compare the study arms, we calculated site-specific and pooled incidence rate ratios (IRRs) and mortality rate ratios (MRRs) for vaginal and vulvar cancers using Poisson regression.
RESULTS: During 3,5 million person-years of follow-up, the IRR for vaginal cancer in the HPV arm compared to the cytology arm was 0.40 (95% CI 0.17-0.88) and the corresponding MRR was 0.74 (95% 0.21-2.24). The corresponding IRR for vulvar cancer was 0.73 (95% 0.50-1.08) and the MRR was 0.64 (95% 0.23-1.62). The pooled IRR was 0.67 (95% 0.47 ̶ 0.95) and MRR 0.67 (95% 0.31 ̶ 1.37).
CONCLUSIONS: We found lower incidence of vaginal cancers with HPV screening compared to cytology screening. To validate our results, we recommend analyzing data on vaginal and vulvar cancers also from other HPV screening studies.
METHODS: Between 2003 and 2008, over 236,000 women were individually randomized (1:1) to primary HPV or cytology screening in Southern Finland. We followed this cohort up to the year 2020. To compare the study arms, we calculated site-specific and pooled incidence rate ratios (IRRs) and mortality rate ratios (MRRs) for vaginal and vulvar cancers using Poisson regression.
RESULTS: During 3,5 million person-years of follow-up, the IRR for vaginal cancer in the HPV arm compared to the cytology arm was 0.40 (95% CI 0.17-0.88) and the corresponding MRR was 0.74 (95% 0.21-2.24). The corresponding IRR for vulvar cancer was 0.73 (95% 0.50-1.08) and the MRR was 0.64 (95% 0.23-1.62). The pooled IRR was 0.67 (95% 0.47 ̶ 0.95) and MRR 0.67 (95% 0.31 ̶ 1.37).
CONCLUSIONS: We found lower incidence of vaginal cancers with HPV screening compared to cytology screening. To validate our results, we recommend analyzing data on vaginal and vulvar cancers also from other HPV screening studies.
摘要：
目的：约70%的阴道癌和40-50%的外阴癌归因于人乳头瘤病毒（HPV）。在全球范围内，由于HPV流行率的增加和全球人口的快速老龄化，这些疾病的负担估计会增加。我们的目的是检查HPV筛查宫颈癌是否在预防阴道癌和外阴癌方面具有额外的有益作用。为了评估这一点，我们使用了芬兰随机HPV筛查试验的长期随访数据.
方法：在2003年至2008年之间，在芬兰南部，超过236,000名妇女被单独随机（1:1）接受原发性HPV或细胞学筛查。我们跟踪这个队列到2020年。为了比较研究武器，我们使用Poisson回归计算了阴道癌和外阴癌的部位特异性和合并发病率比(IRRs)和死亡率比(MRR).
结果：在350万人年的随访中，与细胞学组相比,HPV组阴道癌的IRR为0.40(95%CI0.17-0.88),相应的MRR为0.74(95%0.21-2.24).外阴癌的相应IRR为0.73（95％0.50-1.08），MRR为0.64（95％0.23-1.62）。合并的内部收益率为0.67(95%0.47-0.95)和MRR为0.67(95%0.31-1.37)。
结论：我们发现，与细胞学筛查相比，HPV筛查的阴道癌发病率较低。为了验证我们的结果，我们建议分析来自其他HPV筛查研究的阴道癌和外阴癌数据.
方法：在2003年至2008年之间，在芬兰南部，超过236,000名妇女被单独随机（1:1）接受原发性HPV或细胞学筛查。我们跟踪这个队列到2020年。为了比较研究武器，我们使用Poisson回归计算了阴道癌和外阴癌的部位特异性和合并发病率比(IRRs)和死亡率比(MRR).
结果：在350万人年的随访中，与细胞学组相比,HPV组阴道癌的IRR为0.40(95%CI0.17-0.88),相应的MRR为0.74(95%0.21-2.24).外阴癌的相应IRR为0.73（95％0.50-1.08），MRR为0.64（95％0.23-1.62）。合并的内部收益率为0.67(95%0.47-0.95)和MRR为0.67(95%0.31-1.37)。
结论：我们发现，与细胞学筛查相比，HPV筛查的阴道癌发病率较低。为了验证我们的结果，我们建议分析来自其他HPV筛查研究的阴道癌和外阴癌数据.
